The Pharmaceutical Journal
Vol 277 No 7429 p659
2 December 2006

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HAART adherence barriers similar across settings and countries

Barriers to adherence to highly active antiretroviral therapy (HAART) are largely consistent across multiple settings and countries, a recent study suggests (PLoS Medicine 2006;3[11]:e438).

The study — a systematic review of 37 qualitative studies and 47 surveys (with a quantitative methodology), of which 12 were conducted in developing nations — found that the following important barriers to adherence were reported across the board: fear of disclosure of HIV status; concomitant substance misuse; forgetfulness; suspicions of treatment; too complicated regimens; number of pills required; decreased quality of life; work and family responsibilities; sleeping at the time a dose is required; and access to medicines.

Sonali Sonecha, lead pharmacist HIV services, North Middlesex Hospital, speaking on behalf of the HIV Pharmacy Association, said that the study offers a good starting point for considering what the true barriers to treatment adherence might be, enabling pharmacists to develop strategies to overcome such barriers. Ms Sonecha said that, although more antiretroviral drugs have become available over the past three to four years, treatment has become simpler to take (eg, fewer pills, fewer food restrictions). “HIV is now viewed as a chronic illness and patients can expect to be on regular drug treatment for many years,” she pointed out.

“Whereas before,” she said, “the focus would have been on giving practical advice on managing complex regimens, now pharmacists are involved in supporting patients in maintaining good adherence over a long period of time.”

According to the study, patients in developed nations identified important facilitators to adherence as: having a sense of self-worth; seeing positive effects of antiretrovirals; accepting their HIV seropositivity; understanding the need for strict adherence; making use of reminder tools; and having a simple regimen.