title: Qualitative analysis of barriers and facilitators encountered by HIV patients in an ART adherence programme.
abstract: BACKGROUND
  Medication adherence is a complex, dynamic and changing behaviour that is affected by a variety of factors, including the patient's beliefs and life circumstances. Studies have highlighted barriers to medication adherence (e.g., unmanaged side effects or a lack of social support), as well as facilitators of medication adherence (e.g., technical simplicity of treatment and psychological acceptance of the disease). Since August 2004, in Lausanne (Switzerland), physicians have referred patients who are either experiencing or are at risk of experiencing problems with their HIV antiretroviral treatment (ART) to a routine interdisciplinary ART adherence programme. This programme consists of multifactorial intervention including electronic drug monitoring (MEMS™).
  
  
  OBJECTIVE
  This study's objective was to identify the barriers and facilitators encountered by HIV patients with suboptimal medication adherence (≤90 % adherence over the study period).
  
  
  METHODS
  The community pharmacy of the Department of Ambulatory Care and Community Medicine in Lausanne (Switzerland).
  
  
  METHODS
  The study consisted of a retrospective, qualitative, thematic content analysis of pharmacists' notes that were taken during semi-structured interviews with patients and conducted as part of the ART adherence programme between August 2004 and May 2008.
  
  
  METHODS
  Barriers and facilitators encountered by HIV patients.
  
  
  RESULTS
  Barriers to and facilitators of adherence were identified for the 17 included patients. These factors fell into three main categories: (1) cognitive, emotional and motivational; (2) environmental, organisational and social; and (3) treatment and disease.
  
  
  CONCLUSIONS
  The pharmacists' notes revealed that diverse barriers and facilitators were discussed during medication adherence interviews. Indeed, the results showed that the 17 non-adherent patients encountered barriers and benefited from facilitators. Therefore, pharmacists should inquire about all factors, regardless of whether they have a negative or a positive impact on medication adherence, and should consider all dimensions of patient adherence. The simultaneous strengthening of facilitators and better management of barriers may allow healthcare providers to tailor care to a patient's specific needs and support each individual patient in improving his medication-related behaviour.
authors.affiliation: Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Krummenacher
authors.forename: Brenda
authors.initials: B
authors.lastname: Spencer
authors.forename: Sophie
authors.initials: S
authors.lastname: Du Pasquier
authors.forename: Olivier
authors.initials: O
authors.lastname: Bugnon
authors.forename: Matthias
authors.initials: M
authors.lastname: Cavassini
authors.forename: Marie P
authors.initials: MP
authors.lastname: Schneider
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D001294:Attitude to Health; D015331:Cohort Studies; D003157:Community Pharmacy Services; D016903:Drug Monitoring; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D057285:Precision Medicine; D011787:Quality of Health Care; D012189:Retrospective Studies; D013557:Switzerland; D000078329:Workforce; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents