title: Where we are now and how we can improve: a qualitative study of practitioners' perspectives on providing ART adherence support in Romania.
abstract: Supporting medication adherence is a priority in HIV care worldwide as low adherence threatens the effectiveness of antiretroviral treatment (ART). While evidence on adherence causes and consequences has steadily accumulated, investigating current practice and relevant determinants of practitioners' behaviors has only recently been highlighted as essential for developing effective and sustainable interventions. In Romania, ART adherence is low despite universal access to HIV care, and improving support services is a priority. We report a qualitative exploration of practitioners' experiences and views on ART adherence support, guided by current behavioral theory. Semi-structured interviews were performed with 10 practitioners from six HIV centers, aiming for maximum variation sampling on professional experience, location, and organization type. Questions addressed practitioners' views and experiences on assessing patients' adherence behaviors and determinants, content and format of adherence support, and perceived influences on their capacity to deliver support. Verbatim transcripts were analyzed via template analysis. Results show that adherence support is provided in Romania by trained psychologists in multidisciplinary teams that operate flexibly and perform multiple HIV care activities. Assessment of adherence behaviors and determinants is primarily interview-based, and practitioners use mostly psychotherapeutic techniques and theories with a degree of intervention tailoring. Practitioners' descriptions covered a broad range of common determinants and behavior change techniques, but showed limited use of behavioral theory. Participants also described difficulties to cope with limited resources, and lack of support for managing practical and emotional challenges. Several opportunities for improvement were identified, such as standardizing patient profiling and intervention delivery, conceptualizing and recording active intervention content based on behavioral theory, and actively monitoring intervention effectiveness. This qualitative inquiry provided valuable information for improving adherence support in this clinical context. Understanding practitioners' perspectives based on behavioral theory-informed analyses can help intervention developers increase intervention fidelity by integrating current practice information in program design.
authors.affiliation: a Amsterdam School of Communication Research ASCoR, Communication Science , University of Amsterdam , Amsterdam, Netherlands.
authors.forename: Alexandra Lelia
authors.initials: AL
authors.lastname: Dima
authors.affiliation: a Amsterdam School of Communication Research ASCoR, Communication Science , University of Amsterdam , Amsterdam, Netherlands.
authors.forename: Annemiek J
authors.initials: AJ
authors.lastname: Linn
authors.affiliation: b Baylor Black Sea Foundation at the Centrul Clinic de Excelență-Spitalul Clinic de Boli Infecțioase Constanța- Baylor College of Medicine - Texas Children's Hospital - Abbott Fund , Constanța, Romania.
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Schweitzer
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D018802:Patient-Centered Care; D010465:Perception; D036301:Qualitative Research; D012383:Romania; D012944:Social Support
chemical_list: D019380:Anti-HIV Agents
keywords: Adherence; antiretroviral therapy; implementation; qualitative research; service providers