TY - JOUR
T1 - Exploring the barriers to the antiretroviral therapy adherence among people living with HIV in Bangladesh
T2 - A qualitative approach
AU - Hossain, Fariha
AU - Hasan, Mahmudul
AU - Begum, Nilufar
AU - Mohan, Devi
AU - Verghis, Sharuna
AU - Jahan, Nowrozy Kamar
N1 - Funding Information:
We would like to acknowledge the active cooperation of our study participants for their valuable time to participate in this research project and share their experiences. We also would like to thank the Ashar Alo Society (AAS) team for their dynamic assistance during the data collection. Especially we would like to recognize the active cooperation of Mr Hussain, a trained senior counsellor of AAS, who was ready to provide active counselling support to our study respondents if needed during the data collection process. The authors would like to acknowledge the Monash University to provide permission to use Monash University Malaysia library’s extensive resources, mainly to access all required full-text articles while doing a literature review. In addition, Monash University also allowed the authors to use Endnote software to manage references and Nvivo software to extract the data for analysis.
Publisher Copyright:
© 2022 Hossain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2022/10/21
Y1 - 2022/10/21
N2 - Introduction Since the evolution of highly active antiretroviral therapy (ART), a near-perfect ART adherence level (>95%) is needed to control viral suppression. Non-adherence to treatment may lead to acquired immunodeficiency syndrome (AIDS) and drug resistance. Though the Bangladesh government provides free treatment and counselling services to people living with human immunodeficiency virus (PLHIV), only 22% of the identified PLHIV continue treatment. Therefore, this study aims to explore the barriers that obstruct the Bangladeshi PLHIV to ensure ART adherence. Methods We conducted a qualitative study in Dhaka, Bangladesh, and recruited the sensitive study population following non-probability, mainly purposive sampling from a community-based registered organization for PLHIV. We conducted the in-depth interview using a semi-structured guideline with 15 consented respondents. We transcribed the audio-recorded interviews in the local language (Bangla) and then translated those into English for data analysis. During the data extraction process, the lead and corresponding authors independently extracted raw data to generate different themes and sub-themes and invited other authors to contribute when they could not solve any discrepancies. Results The study identified three significant categories of barriers at the individual, community, and institutional levels that negatively interfered with ART adherence. The most dominant barriers were discrimination and rejection related to stigma, as almost all participants mentioned these barriers. Stigmatizing attitudes and the discriminatory act of the community people and healthcare providers critically affected their treatment adherence. Other leading barriers were improper inventory management of ART-related medicines and CD4 tests and lack of proper counselling. In addition, we found that a positive approach toward life and family support motivated some respondents to overcome the barriers. Conclusions We recommended strengthening Bangladesh’s HIV/AIDS prevention, treatment, and management program with a special focus on the improvement of the supply chain of ART-related medicines and CD4 tests and ensuring proper counselling. In addition, we recommended strengthening the behaviour change communication and IEC activities at a large scale to destigmatize health facilities and community levels.
AB - Introduction Since the evolution of highly active antiretroviral therapy (ART), a near-perfect ART adherence level (>95%) is needed to control viral suppression. Non-adherence to treatment may lead to acquired immunodeficiency syndrome (AIDS) and drug resistance. Though the Bangladesh government provides free treatment and counselling services to people living with human immunodeficiency virus (PLHIV), only 22% of the identified PLHIV continue treatment. Therefore, this study aims to explore the barriers that obstruct the Bangladeshi PLHIV to ensure ART adherence. Methods We conducted a qualitative study in Dhaka, Bangladesh, and recruited the sensitive study population following non-probability, mainly purposive sampling from a community-based registered organization for PLHIV. We conducted the in-depth interview using a semi-structured guideline with 15 consented respondents. We transcribed the audio-recorded interviews in the local language (Bangla) and then translated those into English for data analysis. During the data extraction process, the lead and corresponding authors independently extracted raw data to generate different themes and sub-themes and invited other authors to contribute when they could not solve any discrepancies. Results The study identified three significant categories of barriers at the individual, community, and institutional levels that negatively interfered with ART adherence. The most dominant barriers were discrimination and rejection related to stigma, as almost all participants mentioned these barriers. Stigmatizing attitudes and the discriminatory act of the community people and healthcare providers critically affected their treatment adherence. Other leading barriers were improper inventory management of ART-related medicines and CD4 tests and lack of proper counselling. In addition, we found that a positive approach toward life and family support motivated some respondents to overcome the barriers. Conclusions We recommended strengthening Bangladesh’s HIV/AIDS prevention, treatment, and management program with a special focus on the improvement of the supply chain of ART-related medicines and CD4 tests and ensuring proper counselling. In addition, we recommended strengthening the behaviour change communication and IEC activities at a large scale to destigmatize health facilities and community levels.
KW - Antiretroviral therapy (ART)
KW - HIV infections
KW - Adherence
KW - Bangladesh
KW - Qualitative
UR - http://www.scopus.com/inward/record.url?scp=85140417418&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0276575
DO - 10.1371/journal.pone.0276575
M3 - Article
C2 - 36269716
AN - SCOPUS:85140417418
SN - 1932-6203
VL - 17
JO - PLoS ONE
JF - PLoS ONE
IS - 10
M1 - e0276575
ER -
