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Barriers to Adherence Among Patients On HAART Authors: Tendani Gaolathe 1, Ava Avalos2, Chris Vanderwarker2, Ndwapi Ndwapi1, Geoffrey Tirelo1, Didi Motsepe1, Andrew Mujugira1, Reginal Okezie1, Hermann Bussmann2, William Wester2, Howard Moffat1, Max Essex2,3 and Richard Marlink2,3. Affiliations: 1 Infectious Disease Care Clinic; Princess Marina Hospital, Gaborone, Botswana, 2 Botswana-Harvard AIDS Institute Partnership for HIV Research and Education, 3 Harvard School of Public Health, Department of Immunology and Infectious Disease, Boston, USA Track: C17, Clinical experience with ARVs in Africa Background: In January 2001 Botswana initiated anti-retroviral therapy at the Infectious Disease Care Clinic at Princess Marina Hospital, Gaborone. Documenting barriers to adherence among the patient population is essential to develop accurate and sensitive counseling and support mechanisms at the IDCC. Numerous studies have identified the importance of adherence on the efficacy of antiretroviral therapy. Methods: A series of focus groups, semi-structured interviews, and questionnaires will be administered to a randomly selected group of patients presenting for care at the IDCC. These patients will be divided into two groups, patients initiating therapy and those on therapy for 9 or more months. These qualitative and quantitative techniques will solicit information about barriers to adherence, quality of life, quality of care, social support networks, and stigma and discrimination. In addition, patient responses will be compared to interview responses from key health care providers, including clinic staff and community based organizations such as patient advocacy groups and hospice providers. Results: Qualitative data will be analysed for thematic content, focusing in particular on comparing responses among treatment initiators and those on therapy for 9 or more months. Quantitative data will be used to provide a cross-sectional demographic survey of patients, in addition to information about traditional healthcare utilization, perceived quality of care, and social support networks. Data from patients and healthcare providers will be compared to better understand patient response across different levels of healthcare utilization. Conclusions/Recommendations: Data from this study will be used to refine counseling techniques and sensitize clinic orientation to local needs. Currently, clinic protocol includes group counseling by rotating staff from nursing, pharmacy, and social services. In addition, individual counseling is performed at treatment initiation by trained adherence counselors. During therapy, physicians enforce adherence through ongoing education and pharmacy staff routinely performs pill-counts, demonstration of regimen, and verbally instructions with education materials. |