If You Build It, Will They Use It? Preferences for Antiretroviral Therapy (ART) Adherence Monitoring Among People Who Inject Drugs (PWID) in Kazakhstan

  • Alissa DavisEmail author
  • Lyailya Sarsembayeva
  • Valeriy Gulyaev
  • Sholpan Primbetova
  • Assel Terlikbayeva
  • Gaukhar Mergenova
  • Robert H. Remien
Original Paper


Adherence to antiretroviral therapy (ART) is an important predictor of long-term treatment success and is associated with optimal individual and public health outcomes. Novel technologies, such as electronic monitoring devices (EMDs) or pharmacokinetic testing, provide more objective measures of ART adherence than traditional measures of adherence (e.g., self-report) and may facilitate improved adherence through the provision of patient feedback. This study examines preferences for ART adherence monitoring among people who inject drugs (PWID) in Kazakhstan. In-depth interviews were conducted with 20 HIV-positive PWID, 18 of their intimate partners, and 7 AIDS Center healthcare providers in Almaty, Kazakhstan. Results indicated that patients varied in their preferences of which strategies would be most effective and acceptable to use in monitoring their adherence. Overall, patients were highly enthusiastic about the potential use of pharmacokinetic testing. Many participants supported the use of EMDs, though some were concerned about having their adherence tracked. Other participants thought reminders through text messaging or smart phone applications would be helpful, though several had concerns about confidentiality and others worried about technological difficulties operating a smart phone. Future studies should evaluate the feasibility and impact of providing quantitative drug levels as feedback for ART adherence using biomarkers of longer-term ART exposure, (i.e., hair sampling or dried blood spot testing).


Antiretroviral therapy adherence People who inject drugs Drug monitoring Kazakhstan 



We would like to thank the individuals that participated in this study.


This study was supported by funding from the HIV Center for Clinical and Behavioral Studies at Columbia University and the New York State Psychiatric Institute through the National Institute of Mental Health (P30MH043520). Dr. Davis also received support from the National Institute of Mental Health (T32MH019139) and the National Institute of Drug Abuse (K01DA044853-01A1).

Compliance with Ethical Standards

Conflict of Interest

Alissa Davis declares that she has no conflict of interest. Lyailya Sarsembayeva declares that she has no conflict of interest. Valeriy Gulyaev declares that he has no conflict of interest. Sholpan Primbetova declares that she has no conflict of interest. Assel Terlikbayeva declares that she has no conflict of interest. Gaukhar Mergenova declares that she has no conflict of interest. Robert H. Remien declares that he has no conflict of interest.

Ethical Approval

This study received approval from institutional review boards at the New York State Psychiatric Institute, Columbia University, and the Kazakhstan School of Public Health. All procedures performed in studies involving human subjects were in accordance with the ethical standards of the institutional and/or National 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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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Social WorkColumbia UniversityNew YorkUSA
  2. 2.Columbia University Global Health Research Center of Central AsiaAlmatyKazakhstan
  3. 3.Division of Gender, Sexuality & Health, HIV Center, New York State Psychiatric InstituteColumbia University Medical CenterNew YorkUSA

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