The purpose of this project was to understand the roles and perspective of healthcare providers in facilitating and improving treatment adherence of high risk HIV positive clients in an ethnically diverse urban HIV treatment clinic. The objectives were to identify barriers and facilitators to adherence, review best practices at each treatment clinic and provide recommendations for improving adherence.
Methods:
Semi-structured interviews were used to gather information regarding factors that contributed to non-adherence to HIV treatment regimens. The perceptions and attitudes of health care providers towards clients who were non-adherent to their prescribed treatment regimen were ascertained. Strategies employed by healthcare providers to facilitate adherence were discussed and shared among the participating clinics. The Social Cognitive Theory and the Logic Model were the conceptual frameworks used to guide the project. Participants included a convenient sample of 12 ethnically diverse care providers; age ranged 28 to 62 years, from three California HIV treatment clinics.
Results:
Themes identified as contributing to poor treatment adherence were mental health status, substance abuse, homelessness, and stigma related to a positive HIV status. Fear and misunderstanding of care providers instructions were also noted as major factors contributing to treatment non-adherence. Healthcare system barriers included, lack of cultural diversity among providers, bureaucratic issues relating to insurance coverage, and clinic times of operation interference with access to specialized services. Incentives for adherence included food, transportation, housing assistance, compassion and staff support. Love and positive reinforcement were the greatest influences of adherence. Implementation of a 2nd Medical Care Coordination Team in the project's primary clinic increased adherence by 5% within a seven month period
Conclusion:
The project demonstrated the need for further investigation on how the factors within the healthcare system, particularly as it relates to insurance, affect adherence. The effectiveness of the assessment tools used to identify clients at high risk for treatment non adherence should also be evaluated.