Qualitative evaluation of a comprehensive strategy to improve adherence in Mexico
P. Torres1, B. Allen-Leigh2, R. León-Casillas3, J. Sierra-Madero3
1National Institute of Public Health - Mexico, Centre for Health Systems Research, Cuernavaca, Mexico, 2National Institute of Public Health - Mexico, Center for Research on Population Health, Cuernavaca, Mexico, 3National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico DF, Mexico
Background: Directly administered antiretroviral therapy (DAART) programs to support HAART adherence remain largely unstudied, especially in lower-income contexts. This qualitative evaluation aimed to explore acceptability and key elements of perceived success of a modified-DAART strategy implemented among people living with HIV (PLWHIV) in Mexico.
Methods: PLWHIV with poor adherence to antiretroviral therapy were invited to participate in an intervention to improve adherence. The comprehensive care strategy involved a social worker visiting PLWHIV at home or work five days/week and then three days/week for six months each. The purposive sample included PLWHIV with different characteristics that might influence acceptability. Twelve audio-taped in-depth interviews (45-60 minutes) were collected at baseline and 1 year follow-up from PLWHIV participating in the intervention. Four social workers from the program were interviewed, and qualitative analysis was done.
Results: PLWHIV with varied characteristics (gender, age, sexual identity, socioeconomic level, HIV+ status disclosure and level of social support) found most aspects of the intervention acceptable. Program elements that PLWHIV perceived as helpful with adherence included: acquiring knowledge about HIV treatment; support in creating a routine or system for remembering to take medicines; help navigating the healthcare system and communicating with healthcare personnel; resolving secondary effects of treatment, and the most important element was help dealing with social-support and emotional barriers to adherence. Some PLWHIV felt they needed a longer period of visits by the social worker.
Conclusions: PLWHIV satisfaction with a social support strategy that includes modified-DARRT is high. Patients and social workers perceived the program as effective in improving adherence, especially the support from social workers, who were able to support PLWHIV in creating their own solutions to their barriers to adherence. Quantitative methods should be used to evaluate intervention impact and cost-effectiveness. When scaling-up, the elements that make the intervention acceptable should be maintained.
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