Individual, social, and structural factors affecting antiretroviral therapy adherence among HIV-positive people who inject drugs in Kazakhstan

• Published in: The International journal of drug policy 2018-12, Vol.62, p.43-50
• Main Authors: Davis, Alissa, McCrimmon, Tara, Dasgupta, Anindita, Gilbert, Louisa, Terlikbayeva, Assel, Hunt, Timothy, Primbetova, Sholpan, Wu, Elwin, Darisheva, Meruyert, El-Bassel, Nabila
• Format: Article
• Language: English
• Subjects: Acquired Immunodeficiency Syndrome - epidemiology; Acquired Immunodeficiency Syndrome - psychology; Acquired Immunodeficiency Syndrome - virology; Adherence; Adult; Anti-HIV Agents - therapeutic use; Anti-Retroviral Agents - administration & dosage; Antiretroviral drugs; Antiretroviral therapy; Barriers; Cities; Clinical outcomes; Constraints; Discrimination; Drug abuse; Drug policy; Drug therapy; Drug use; Drug Users - psychology; Drug Users - statistics & numerical data; Drugs; Epidemics; Female; Forgetfulness; Group research; Health services; Health status; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Intervention; Kazakhstan; Male; Medication Adherence - psychology; Middle Aged; Navigation; Patients; People who inject drugs; Poverty; Prevention; Prevention programs; Preventive medicine; Qualitative Research; Reminders; Risk; Side effects; Social Stigma; Social support; Stigma; Substance abuse treatment; Substance Abuse, Intravenous - epidemiology; Substance Abuse, Intravenous - psychology; Substance Abuse, Intravenous - virology
• ISSN: 0955-3959; 1873-4758
• DOI: 10.1016/j.drugpo.2018.08.014

HIV-infected people who inject drugs (PWID) are particularly vulnerable to suboptimal ART adherence. The fastest-growing HIV epidemics globally are driven by injection drug use, but only a small percentage of HIV-positive PWID have achieved viral suppression. Virally suppressed individuals have better HIV-related health outcomes and effectively no risk of transmitting HIV to others. Hence, ART adherence is important for both HIV treatment and HIV prevention. There is a paucity of data on barriers and facilitators of ART adherence among PWID in low and middle income countries, which is problematic given the growing HIV epidemics among PWID in these countries. Using the Theory of Triadic Influence, this paper examines individual, interpersonal, and structural barriers and facilitators of ART adherence among HIV-positive PWID in four cities in Kazakhstan. Eight focus groups were conducted (two in each city) with a total of 57 participants. Data were coded and analyzed by three researchers. We found a number of barriers and facilitators to ART adherence among PWID at the individual, interpersonal, and structural levels. Individual barriers to ART adherence include misperceptions about ART, forgetfulness due to the effects of illicit drug use, and medication side effects. Interpersonal facilitators of ART adherence include social support and good relationships with healthcare providers. Structural barriers include poverty, legal challenges, disruptions in the ART supply, and stigma and discrimination. The paper highlights important factors related to ART adherence for HIV-positive PWID and identifies potential strategies for intervention efforts, including couple-based interventions, electronic reminders, linkage to drug treatment services, and patient navigation. Effectively enhancing adherence to ART among PWID will likely require multi-level approaches and strategies. Further research should be conducted on potential methods and interventions for improving ART adherence among this vulnerable population.