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Client and Provider Perspectives on Antiretroviral Treatment Uptake and Adherence Among People Who Inject Drugs in Indonesia, Ukraine and Vietnam: HPTN 074

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Abstract

HIV-infected people who inject drugs (PWID) have low uptake of HIV services, increasing the risk of transmission to uninfected injection or sexual partners and the likelihood of AIDS-related deaths. HPTN 074 is a vanguard study assessing the feasibility of an integrated intervention to facilitate treatment as prevention to PWID in Indonesia, Ukraine, and Vietnam. We describe barriers to and facilitators of ART uptake and adherence among PWID. We conducted in-depth interviews with 62 participants, including 25 providers and 37 PWID at baseline across all sites. All interviews were recorded, transcribed, translated into English and coded in NVivo for analysis. Matrices were developed to identify emergent themes and patterns. Overall, differences between provider and PWID perspectives were greater than differences in cross-site perspectives. Providers and PWID recognized clinic access, financial barriers, side effects, and lack of information about HIV testing and ART enrollment as barriers to ART. However, providers tended to emphasize individual level barriers to ART, such as lack of motivation due to drug use, whereas PWID highlighted health systems barriers, such as clinic hours and financial burden, fears, and side effects. Providers did not mention stigma as a barrier though their language reflected stereotypes about drug users. The differences between provider and PWID perspectives suggest a gap in providers’ understanding of PWID. This misunderstanding has implications for patient-provider interactions that may affect PWID willingness to access care or adhere to ART. Lessons learned from this study will be important as countries with a significant HIV burden among PWID design and implement programs to engage HIV-infected PWID in care and treatment.

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Acknowledgements

We would like to thank the members of the HPTN 074 study site teams for their hard work and dedication to this project, including Kristiana Siste and Lidya Heryanto of the Psychiatric Department at the University of Indonesia for conducting all in-depth interviews at the Indonesia site; Olena Makarenko, MD, PhD, Irina Zaviryukha, MD, Svitlana Antonyak, MD at the Ukraine site; and Vu Thanh Nhan and Nguyen Nhu Trang for conducting all interviews at the Vietnam site. We are grateful for the support from NGO “Club Eney”; Gromashevsky Institute of Epidemiology and Infectious Diseases; and the Viet Nam Administration for HIV/AIDS Control (VAAC). Lastly, we would like to thank the participants for their invaluable contributions to this research.

Funding

This work was supported by the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Mental Health (NIMH), and the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH); Award Numbers UM1AI068619 [HPTN Leadership and Operations Center], UM1AI068617 [HPTN Statistical and Data Management Center], UM1AI068613 [HPTN Laboratory Center], and the University of North Carolina at Chapel Hill Center for AIDS Research (P30 AI50410). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA

    Vivian F. Go & Rebecca B. Hershow

  2. Ukrainian Institute on Public Health Policy, Malopidvalna Street, 4, Kiev, 02000, Ukraine

    Tetiana Kiriazova

  3. National Narcotics Board, Jalan Letnan Jendral M.T. Haryono No.11, RT.1/RW.6, Cawang, Kramatjati, RT.1/RW.6, Cawang, Kramatjati, Kota Jakarta Timur, Daerah Khusus Ibukota, Jakarta, 13630, Indonesia

    Riza Sarasvita

  4. Cipto Mangunkusumo Hospital, University of Indonesia, Jalan Pangeran Diponegoro No.71, Salemba, Senen, Jakarta Pusat, Daerah Khusus Ibukota, Jakarta, 10430, Indonesia

    Riza Sarasvita

  5. UNC Project Vietnam, Yen Hoa Health Clinic, Lot E2, Duong Dinh Nghe Street, Cau Giay District, Hanoi, Vietnam

    Quynh Bui

  6. Department of Health, Behavior, and Society, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA

    Carl A. Latkin

  7. Science Facilitation Department, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA

    Scott Rose & Erica Hamilton

  8. Division of Epidemiology, College of Public Health, The Ohio State University, 300-D Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA

    Kathryn E. Lancaster & William C. Miller

  9. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 4th Floor - Suite 4000, Philadelphia, PA, 19104-3309, USA

    David Metzger

  10. Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC, 27599, USA

    Irving F. Hoffman

Authors
  1. Vivian F. Go
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  2. Rebecca B. Hershow
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  3. Tetiana Kiriazova
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  4. Riza Sarasvita
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  5. Quynh Bui
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  6. Carl A. Latkin
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  7. Scott Rose
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  8. Erica Hamilton
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  9. Kathryn E. Lancaster
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  10. David Metzger
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  11. Irving F. Hoffman
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  12. William C. Miller
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Corresponding author

Correspondence to Vivian F. Go.

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Conflict of interest

Vivian F. Go declares that she has no conflict of interest. Rebecca B. Hershow declares that she has no conflict of interest. Tetiana Kiriazova declares that she has no conflict of interest. Quynh Bui declares that she has no conflict of interest. Carl A. Latkin declares that he has no conflict of interest. Scott Rose declares that he has no conflict of interest. Erica Hamilton declares that she has no conflict of interest. Kathryn E. Lancaster declares that she has no conflict of interest. David Metzger declares that he has no conflict of interest. Irving F. Hoffman declares that he has no conflict of interest. William C. Miller declares that he has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human subjects were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Go, V.F., Hershow, R.B., Kiriazova, T. et al. Client and Provider Perspectives on Antiretroviral Treatment Uptake and Adherence Among People Who Inject Drugs in Indonesia, Ukraine and Vietnam: HPTN 074. AIDS Behav 23, 1084–1093 (2019). https://doi.org/10.1007/s10461-018-2307-y

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