Dealing With the Obstacles in Adhering to Highly Active Antiretroviral Therapy

The impact of illustrated side effect information on understanding and sustained retention of antiretroviral side effect knowledge

BACKGROUND

Prompt management of side effects is critical to supporting adherence to antiretroviral (ARV) medication.

OBJECTIVE

This study examines the impact of presenting side effect information using simple text combined with pictograms on sustained knowledge of ARV side effects over three months.

METHOD

Previously designed side effect pictograms, combined with simple text, were incorporated into a side effects panel within an ARV information leaflet. In a randomised controlled study, 116 limited literacy HIV patients taking ARVs were randomly allocated to either control (standard care) or intervention groups (standard care plus illustrated information). Side effect knowledge was assessed at baseline, and intervention patients received the illustrated leaflet. Knowledge was re-tested at one and three months. Interpretation of side effect pictograms was evaluated at one month.

RESULTS

In intervention patients, mean side effect knowledge increased from 45.9% (baseline) to 95.7% (three months; p<0.0001), and pictogram interpretation was good. Knowledge did not change significantly in the control group. All found the pictograms clear and useful, and endorsed their routine use.

CONCLUSIONS

Providing patients with simple written information containing pictograms on ARV side effects significantly improved side effect knowledge, sustained over time, in limited literacy, rural South African HIV patients.

Access to and utilization of healthcare: the provider's role

Access to and utilization of healthcare are distinct, yet related, concepts that serve as a focus for health policy and quality improvement. This article identifies their similarities and differences, calling on previous research and reviews to elaborate on a current understanding of factors that influence both, with a particular focus on those related to the healthcare provider. Access describes an individual's ability to position oneself to receive healthcare services. Utilization presumes access and includes the formulation of a healthcare plan during a healthcare encounter and its subsequent implementation. We present a framework that envisions access and utilization as aspects of healthcare delivery that may be affected by the context within which services are delivered, the structure of the practice that delivers them and other processes leading to outcomes experienced by the healthcare consumer. Based on current trends, we anticipate that research and policy related to access and utilization over the next 5 years will be primarily driven by a focus on quality improvement. Providers are positioned to use their collective authority to exercise influence on access and quality at the individual, institutional and policy levels.

HIV-infected patients' adherence to highly active antiretroviral therapy: a phenomenological study

Adherence to the treatment regimen is essential to the success of highly active antiretroviral therapy for patients who are infected with HIV. The evidence suggests that poor adherence to antiretroviral drug therapy is a major problem that has the potential to diminish effective viral suppression, promote viral resistance, and place patients at risk for hospitalization, opportunistic infections, and an increased risk of HIV transmission. The primary aim of this study was to understand patients' experiences regarding their adherence to antiretroviral drug therapy. Thus, 19 participants were recruited for in-depth interviews regarding their adherence to drug regimens. All the interviews were transcribed verbatim and analyzed by using Benner's phenomenological analysis approach. Four main themes emerged from the data: (i) choosing to live and the decision to start taking medications; (ii) strategies for adhering to the regimen and managing the side-effects; (iii) relationships with healthcare providers; and (iv) advantages of the medications as a motivator to continue one's adherence to the regimen. Studying and understanding the experiences of patients can provide new insights and strategies in order to enhance patients' adherence to highly active antiretroviral therapy.

How do subjectively-constructed meanings ascribed to anti-HIV treatments affect treatment-adherent practice?

Anti-HIV treatment-adherent practice is a significant issue in HIV medical discourses on effective disease treatment and management. Findings from research studies into treatment (non)adherence have positioned the act as a medical issue that could be remedied by behavioral strategies. The present study, conducted in Sydney, Australia, aims to examine treatment-(non)adherent practice as a subjective expression of meanings ascribed to treatments by employing a narrative analytical approach informed by poststructuralist epistemology. The findings indicate that people with HIV negotiate and position treatments in particular ways that lead to multiple and varied understanding of treatments. The ways treatments are positioned in their everyday lives suggest that meanings ascribed to treatments impact on the way individuals negotiate demands embedded in the medically-constructed practice of adherence.