Marseille 2007
| Abstract #526 - Barriers to ARV Medication Adherence and Implications for Intervention Design: Focus Groups with Ugandan Military Personnel, Spouses, and Healthcare Providers | ||||
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Session: 26.71: Posters B (Poster) on Tuesday in Chaired by Authors: Presenting Author: Mrs Wynne Norton - University of Connecticut, United States |
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| Additional Authors: Dr Jason Seacat, MA Susan Kiene, Dr Deborah Cornman, MA Caroline Redding, Major Godfrey Bwire, Major Stephen Kusasira, Major Kenneth Ocen, MD Stephanie Brodine, Dr Jeffrey Fisher, | ||||
| Aim: Optimal adherence to ARVs is essential to PLWHA. As ARVs become more widely disseminated worldwide, it becomes increasingly important to understand the specific factors that contribute to medication-taking behavior so that effective programs can be developed to support ARV adherence. Little research has examined factors related to nonadherence among a developing countrys military population, for whom barriers to adherence may be unique. HIV/AIDS presents a challenge to the viability of the armed forces in Uganda, with HIV prevalence estimates among members of the Ugandas Peoples Defense Force significantly higher than those in the general population. In order to develop an ARV adherence program for HIV+ military members and their spouses, we conducted formative qualitative research with military personnel, spouses, and healthcare providers at two hospitals in Kampala, Uganda. The objectives of this study were to understand the unique factors that challenge adherence in this specific population. | ||||
| Method / Issue: This study was informed by the Information-Motivation-Behavioral Skills model of adherence. Formative research was conducted to elicit specific information, motivation, and behavioral skills-related factors that were related to suboptimal adherence among HIV+ military members. Five focus groups were conducted. These included two groups of HIV+ soldiers (n = 19), two groups of healthcare providers and clinicians (n = 17), and one combined group of HIV+ female soldiers and HIV+ female spouses of soldiers (n = 13), for a total of 55 participants. Focus groups were audio recorded, transcribed, and analyzed using traditional qualitative data methodology. Consistent themes were noted, tabulated as to frequency, and illustrated with representative quotations. | ||||
| Results / Comments: Misinformation that reduced adherence included the belief that ARVs are toxic; that church, God, and traditional healers can cure HIV/AIDS; and that ARVs are not needed once a persons health improves. Motivational factors included frustration at taking medications for the rest of ones life; fears of disclosure; and experience of negative side effects. Behavioral skills-related factors included (1) inability to mitigate side effects, (2) difficulty remembering to take medications when deployed, busy with other tasks, taking medications more than once a day, and when intoxicated, and (3) difficulties disclosing HIV status. Structural barriers were primarily driven by conditions associated with poverty: lack of transportation to get medications and lack of food and clean water to take with medications. Participants also provided suggestions for the development of a program to help improve adherence, including education about adherence and HIV; social support from HIV+ peers and military commanders; and skills training in creating cues for taking medications, such as cell phones alarms. | ||||
| Discussion: While many of the adherence-related barriers parallel those commonly experienced by PLWHA in other countries, some of the barriers are unique to this culture and setting, and require thorough examination in the development of a program to increase ARV adherence in the Ugandan military. Future endeavors to create adherence support programs for military personnel need to take into account not only information, motivation, and behavioral skills factors associated with suboptimal adherence, but specific cultural and structural factors relevant to this population as well. | ||||
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