Title

Improving adherence to highly active anti-retroviral therapy (HAART) among people living with HIV/AIDS in northern Thailand

Date of Award

1-1-2007

Degree Type

Thesis

Degree Name

Doctor of Philosophy

School

School of Nursing, Midwifery and Postgraduate Medicine

Faculty

Faculty of Communications, Health and Science

Abstract

Background: This study explored the experiences of people living with HIV/AIDS (PLWHA) in a region of Northern Thailand and Key Informants (Kls). The principal aim of the study was to gain an in-depth understanding of the factors contributing to non-adherence in patients taking Highly Active Anti-Retroviral Therapy (HAART). The data from both PL WHA and Kls were integrated and. analysed to provide an intervention programs aimed at improving adherence in patients commencing HAART. The study itself was divided into three Phases: Phase One was an in-depth exploration of the barriers and ways of improving adherence, Phase Two comprised a series of interventions aimed at patients starting HAART for the first time and Phase Three evaluated the effectiveness of these interventions. Study Population: The study population in Phase One comprised a cohort of 32 HIV infected patients who were over 18 years old and had taken HAART for at least 6 months. Another cohort was comprised 21 Kls who had experience working with HIV care and patients taking HAART. In Phase Two, the population comprised 22 HIV infected patients who were commencing HAART for the first time. After 3 months these same participants were reinterviewed for Phase Three of the study to assess the effectiveness and acceptability of the interventions. Methods: Both qualitative and quantitative data collection methods were used in the study. The qualitative component used a multiple case study approach to explore and describe the experiences of patients receiving HAART. The study was strengthened by the inclusion of in-depth interviews with Kls with extensive knowledge and experience with HIV/AIDS and HAART programs. The quantitative component comprised a demographic survey of both the patients and Kls. This demographic data was used to provide descriptive statistics of the research population and assist with the interpretation of the qualitative data. Results: The findings from Phase One identified a number of interventions that could realistically be implemented to improve medication adherence on patients commencing HAART for the first time. The Phase Three findings showed there were improvements in the patient's adherence to HAAR T during the 3 months of implementing the interventions. The study identified a number of recommendations that Health Care Providers (HCPs) and policy makers could implement to improve medication adherence rates in patients taking HAAR T. The recommendations also included suggestions for future research, Conclusion: The financial and social burden of PL WHA presents an urgent challenge to policy-makers and Health Care Providers to identify sensitive and cost effective management strategies to support such patients and their families. One of the most crucial challenges is to develop interventions that enable patients to gain optimum benefit from the new advances in HIV treatment. A key factor in optimising the benefits of HIV treatment is improving adherence to treatment. The findings from the present study outline a number of interventions that can be cost effectively implemented to improve adherence to HAART and the quality of life of people living with HIV/AIDS.

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