title: Antiretroviral therapy adherence strategies used by patients of a large HIV clinic in Lesotho.
abstract: A high degree of adherence to antiretroviral therapy (ART) in patients infected with human immunodeficiency virus (HIV) is necessary for long term treatment effects. This study explores the role of timing of ART intake, the information patients received from health workers, local adherence patterns, barriers to and facilitators of ART among 28 HIV-positive adults at the Senkatana HIV Clinic in Maseru, Lesotho. This qualitative, semi-structured interview study was carried out during February and March of 2011 and responses were analyzed inspired by the Grounded Theory method. Results were then compared and discussed between the authors and the main themes that emerged were categorized. The majority of the respondents reported having missed one or more doses of medicine in the past and it was a widespread belief among patients that they were required to skip the dose of ART if they were "late". The main barriers to adherence were interruptions of daily routines or leaving the house without sufficient medicine. The use of mobile phone alarms, phone clocks and support from family and friends were major facilitators of adherence. None of the patients reported to have been counseled on family support or the use of mobile phones as helpful methods in maintaining or improving adherence to ART. Being on-time with ART was emphasized during counseling by health workers. In conclusion, patients should be advised to take the dose as soon as they remember instead of skipping the dose completely when they are late. Mobile phones and family support could be subjects to focus on during future counseling particularly with the growing numbers of mobile phones in Africa and the current focus on telemedicine.
authors.affiliation: Department of Medicine, Copenhagen University Hospital Glostrup, Glostrup, Denmark. jm.axelsson@gmail.com.
authors.forename: Johanna Maria
authors.initials: JM
authors.lastname: Axelsson
authors.affiliation: Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark.
authors.forename: Sofie
authors.initials: S
authors.lastname: Hallager
authors.affiliation: Department of Medicine, Roskilde University Hospital, Roskilde, Denmark.
authors.forename: Toke S
authors.initials: TS
authors.lastname: Barfod
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000554:Ambulatory Care Facilities; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D040421:Cell Phone; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D066296:Grounded Theory; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006801:Humans; D007927:Lesotho; D008297:Male; D055118:Medication Adherence / Q000208:ethnology; D008875:Middle Aged; D008960:Models, Psychological; D010353:Patient Education as Topic; D057566:Self Report; D012944:Social Support; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
references.citation: AIDS. 2003 Oct 17;17(15):F33-7
references.pmid: 14523294
references.citation: HIV Med. 2006 Jul;7(5):285-90
references.pmid: 16945072
references.citation: J Infect Dis. 2003 Aug 1;188(3):388-96
references.pmid: 12870120
references.citation: Clin Infect Dis. 2009 Feb 15;48(4):484-8
references.pmid: 19140758
references.citation: BMC Public Health. 2008 Feb 18;8:63
references.pmid: 18282286
references.citation: J Acquir Immune Defic Syndr. 2006 Mar;41(3):315-22
references.pmid: 16540932
references.citation: AIDS Care. 2011 Jun;23(6):657-62
references.pmid: 21347887
references.citation: AIDS Patient Care STDS. 2006 Jan;20(1):48-56
references.pmid: 16426156
references.citation: Ann Intern Med. 2003 Nov 18;139(10):810-6
references.pmid: 14623618
references.citation: AIDS Care. 2011 Oct;23(10):1246-53
references.pmid: 21939403
references.citation: PLoS One. 2010 Apr 28;5(4):e10340
references.pmid: 20442769
references.citation: Cochrane Database Syst Rev. 2012 Mar 14;(3):CD009756
references.pmid: 22419345
references.citation: AIDS Care. 2012;24(6):728-36
references.pmid: 22150119
references.citation: J Nurs Scholarsh. 2009;41(2):149-57
references.pmid: 19538699
references.citation: Clin Infect Dis. 2003 Oct 15;37(8):1112-8
references.pmid: 14523777
references.citation: J Acquir Immune Defic Syndr. 2008 Oct 1;49(2):190-5
references.pmid: 18769349
references.citation: JAMA. 2006 Aug 9;296(6):679-90
references.pmid: 16896111
references.citation: Lancet Infect Dis. 2011 Dec;11(12):942-51
references.pmid: 22030332
references.citation: Curr HIV/AIDS Rep. 2011 Sep;8(3):172-80
references.pmid: 21713433
references.citation: PLoS One. 2014 May 14;9(5):e97353
references.pmid: 24828585
references.citation: Antivir Ther. 2008;13 Suppl 2:1-13
references.pmid: 18578063
references.citation: AIDS. 2001 Jun 15;15(9):1181-3
references.pmid: 11416722
references.citation: J Int AIDS Soc. 2010 Sep 23;13:37
references.pmid: 20863399
references.citation: J Acquir Immune Defic Syndr. 2006 Dec 1;43 Suppl 1:S79-87
references.pmid: 17133207
references.citation: J Infect Dis. 2005 Feb 1;191(3):339-47
references.pmid: 15633092
references.citation: AIDS Behav. 2009 Jun;13 Suppl 1:82-91
references.pmid: 19301113
references.citation: HIV Clin Trials. 2007 Jan-Feb;8(1):19-23
references.pmid: 17434845
references.citation: SAHARA J. 2008 Sep;5(3):136-43
references.pmid: 18979047
references.citation: AIDS Care. 2009 Jan;21(1):78-86
references.pmid: 19085223
references.citation: Curr Opin HIV AIDS. 2010 Jan;5(1):70-7
references.pmid: 20046150
references.citation: AIDS Care. 2007 May;19(5):658-65
references.pmid: 17505927