title: A qualitative assessment of barriers and facilitators to antiretroviral adherence in Thai patients.
abstract: OBJECTIVE
  Excellent adherence to combination antiretroviral therapy can suppress HIV replication and produce life expectancies nearing those of individuals without HIV infection. This qualitative study sought to identify the barriers and facilitators to good antiretroviral medication adherence in Thai patients living with HIV.
  
  
  METHODS
  Semi-structured interviews were conducted with a convenience sample (n=21) of patients attending routine clinic visits at Srinagarind Hospital in Khon Kaen, or HIV-NAT, the Thai Red Cross AIDS Research Centre in Bangkok.
  
  
  RESULTS
  Median informant age was 43 years (range 27-60 years) and 43% were female. We identified key facilitators and barriers to adherence among HIV-infected Thai patients along three major themes (patient-related, health system-related and medication-related). Stigma was a primary concern for most informants, operating throughout Thai society to induce feelings of shame for Thai people living with HIV. Determination to stay healthy and incorporate taking cART into their daily routine were key components of good adherence. Supportive and trusting relationships, particularly with the clinic team, empowered patients to maintain good medication adherence.
  
  
  CONCLUSIONS
  Changing public perceptions about HIV, and training of HIV clinic staff on the importance of trusting and supportive provider-patient relationships in promoting good health outcomes, will help Thailand achieve its aim of having zero new HIV infections, zero discrimination and zero AIDS-related deaths by 2030.
authors.affiliation: School of Medicine , University of California , San Francisco , USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Phuphanich
authors.affiliation: Faculty of Pharmaceutical Sciences , Khon Kaen University , Thailand.
authors.forename: Maneerat
authors.initials: M
authors.lastname: Rattanamahattana
authors.affiliation: HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Anchalee
authors.initials: A
authors.lastname: Avihingsanon
authors.affiliation: Faculty of Medicine , Khon Kaen University , Thailand.
authors.forename: Ploenchan
authors.initials: P
authors.lastname: Chetchotisakd
authors.affiliation: Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand.
authors.forename: Opass
authors.initials: O
authors.lastname: Putcharoen
authors.affiliation: School of Medicine , University of California , San Francisco , USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Gandhi
authors.affiliation: TREAT Asia/amfAR -The Foundation for AIDS Research , Bangkok , Thailand.
authors.forename: Annette H
authors.initials: AH
authors.lastname: Sohn
authors.affiliation: Centre for Sexual Health and HIV Research, Department of Infection and Population Health, University College London, UK; Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Imrie
authors.affiliation: HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Praphan
authors.initials: P
authors.lastname: Phanuphak
authors.affiliation: HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Kirby Institute, University of New South Wales, Sydney, Australia; Amsterdam Institute of Global Health and Development (AIGHD), the Netherlands.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kerr
keywords: adherence, HIV, Thailand, Southeast Asia, antiretroviral agents