International Journal of Clinical Pharmacy

, Volume 36, Issue 4, pp 716–724 | Cite as

Qualitative analysis of barriers and facilitators encountered by HIV patients in an ART adherence programme

  • Isabelle Krummenacher
  • Brenda Spencer
  • Sophie Du Pasquier
  • Olivier Bugnon
  • Matthias Cavassini
  • Marie P. SchneiderEmail author
Research Article


Background Medication adherence is a complex, dynamic and changing behaviour that is affected by a variety of factors, including the patient’s beliefs and life circumstances. Studies have highlighted barriers to medication adherence (e.g., unmanaged side effects or a lack of social support), as well as facilitators of medication adherence (e.g., technical simplicity of treatment and psychological acceptance of the disease). Since August 2004, in Lausanne (Switzerland), physicians have referred patients who are either experiencing or are at risk of experiencing problems with their HIV antiretroviral treatment (ART) to a routine interdisciplinary ART adherence programme. This programme consists of multifactorial intervention including electronic drug monitoring (MEMSTM). Objective This study’s objective was to identify the barriers and facilitators encountered by HIV patients with suboptimal medication adherence (≤90 % adherence over the study period). Setting The community pharmacy of the Department of Ambulatory Care and Community Medicine in Lausanne (Switzerland). Method The study consisted of a retrospective, qualitative, thematic content analysis of pharmacists’ notes that were taken during semi-structured interviews with patients and conducted as part of the ART adherence programme between August 2004 and May 2008. Main outcome measure Barriers and facilitators encountered by HIV patients. Results Barriers to and facilitators of adherence were identified for the 17 included patients. These factors fell into three main categories: (1) cognitive, emotional and motivational; (2) environmental, organisational and social; and (3) treatment and disease. Conclusion The pharmacists’ notes revealed that diverse barriers and facilitators were discussed during medication adherence interviews. Indeed, the results showed that the 17 non-adherent patients encountered barriers and benefited from facilitators. Therefore, pharmacists should inquire about all factors, regardless of whether they have a negative or a positive impact on medication adherence, and should consider all dimensions of patient adherence. The simultaneous strengthening of facilitators and better management of barriers may allow healthcare providers to tailor care to a patient’s specific needs and support each individual patient in improving his medication-related behaviour.


HIV Interdisciplinarity Intervention Medication adherence Pharmacists Qualitative research Switzerland 



We acknowledge the members of the Swiss HIV Cohort Study for their support.



Conflict of interest


Supplementary material

11096_2014_9930_MOESM1_ESM.docx (32 kb)
Electronic Supplementary Material (DOCX 33 kb)


  1. 1.
    Sethi AK. Adherence and HIV drug resistance. Hopkins HIV Rep. 2004;16(1):6–8.PubMedGoogle Scholar
  2. 2.
    Sterne JA, Hernan MA, Ledergerber B, Tilling K, Weber R, Sendi P, et al. The Swiss HIV Cohort Stud. Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study. Lancet. 2005;366(9483):378–84.PubMedCrossRefGoogle Scholar
  3. 3.
    Wagels T, Amiet R, Battegay M, Guex AC, Opravil M, Vernazza PL, The Swiss HIV Cohort Study Group. Predictive value of adherence in patients starting highly active antiretroviral treatment for HIV infection. Swiss MedWkly. 2004;134(45–46):678–80.Google Scholar
  4. 4.
    Glass TR, de Geest S, Weber R, Vernazza PL, Rickenbach M, Furrer H, et al. Correlates of self-reported non-adherence to antiretroviral therapy in HIV-infected patients: the Swiss HIV Cohort Study. J Acquir Immune Defic Syndr. 2006;41(3):385–92.PubMedCrossRefGoogle Scholar
  5. 5.
    Ammassari A, Trotta MP, Murri R, Castelli F, Narciso P, Noto P, et al. Correlates and predictors of adherence to highly active antiretroviral therapy: overview of published literature. J Acquir Immune Defic Syndr. 2002;31(Suppl 3):S123–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Gebrekristos HT, Mlisana KP, Karim QA. Patients’ readiness to start highly active antiretroviral treatment for HIV. BMJ. 2005;331(7519):772–5.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Murphy DA, Roberts KJ, Martin DJ, Marelich W, Hoffman D. Barriers to antiretroviral adherence among HIV-infected adults. AIDS Patient Care STDS. 2000;14(1):47–58.PubMedCrossRefGoogle Scholar
  8. 8.
    Remien RH, Hirky AE, Johnson MO, Weinhardt LS, Whittier D, Le GM. Adherence to medication treatment: a qualitative study of facilitators and barriers among a diverse sample of HIV + men and women in four US cities. AIDS Behav. 2003;7(1):61–72.PubMedCrossRefGoogle Scholar
  9. 9.
    Horne R, Cooper V, Gellaitry G, Date HL, Fisher M. Patients’ perceptions of highly antiretroviral therapy in relation to treatment uptake and adherence: the utility of the necessity-concerns framework. J Acquir Immune Defic Syndr. 2007;45(3):334–41.PubMedGoogle Scholar
  10. 10.
    Roberts KJ. Barriers to and facilitators of HIV-positive patients’ adherence to antiretroviral treatment regimens. AIDS Patient Care STDS. 2000;14(3):155–68.PubMedCrossRefGoogle Scholar
  11. 11.
    Beusterien KM, Davis EA, Flood R, Howard K, Jordan J. HIV patient insight on adhering to medication: a qualitative analysis. AIDS Care. 2008;20(2):244–52.PubMedCrossRefGoogle Scholar
  12. 12.
    Vervoort SC, Borleffs JC, Hoepelman AI, Grypdonck MH. Adherence in antiretroviral therapy: a review of qualitative study. AIDS. 2007;21(3):271–81.PubMedCrossRefGoogle Scholar
  13. 13.
    Vervoort SC, Grypdonck MH, de Grauwe A, Hoeperlman AI, Borleffs JC. Adherence to HAART: processes explaining adherence behaviour in acceptors and non-acceptors. AIDS Care. 2009;21(4):431–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Norton WE, Amico KR, Fisher WA, Shuper PA, Ferrer RA, Cornmann DF, et al. Information-motivation-behavioural skills barriers associated with intentional versus unintentional ARV non-adherence behavior among HIV + patients in clinical care. AIDS Care. 2010;22(8):979–87.PubMedCrossRefGoogle Scholar
  15. 15.
    Sidat M, Fairley C, Grierson J. Experiences and perceptions of patients with 100% adherence to highly active antiretroviral therapy: a qualitative study. AIDS Patients Care STDS. 2007;21(7):509–20.CrossRefGoogle Scholar
  16. 16.
    Krummenacher I, Cavassini M, Bugnon O, Schneider MP. An interdisciplinary HIV-adherence program combining motivational interviewing and electronic antiretroviral drug monitoring. AIDS Care. 2011;23(5):550–61.PubMedCrossRefGoogle Scholar
  17. 17.
    Miller WR, Rollnick S, Conforti K. Motivational interviewing: preparing people for change, 2nd ed. New York: The Guilford Press; 2002. ISBN 1572305630, 978-1572305632.Google Scholar
  18. 18.
    Mills EJ, Nachega JB, Bangsberg DR, Singh S, Rachlis B, Wu P, et al. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med. 2006;3(11):e438.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Russel CK, Bunting SM, Graney M, Hartig MT, Kisner P, Brown B. Factors that influence the medication decision making of persons with HIV/AIDS: a taxonomic exploration. J Assoc Nurses AIDS Care. 2003;14(4):46–60.CrossRefGoogle Scholar
  20. 20.
    Simoni JM, Frick PA, Huang B. A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy. Health Psychol. 2006;25(1):74–81.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  • Isabelle Krummenacher
    • 1
  • Brenda Spencer
    • 2
  • Sophie Du Pasquier
    • 3
  • Olivier Bugnon
    • 1
    • 3
  • Matthias Cavassini
    • 4
  • Marie P. Schneider
    • 1
    • 3
    • 5
    Email author
  1. 1.Community Pharmacy, School of Pharmaceutical SciencesUniversity of Geneva, University of LausanneGenevaSwitzerland
  2. 2.Institute of Social and Preventive Medicine (IUMSP)Lausanne University HospitalLausanneSwitzerland
  3. 3.Community Pharmacy, Department of Ambulatory Care and Community MedicineUniversity of LausanneLausanneSwitzerland
  4. 4.Service of Infectious DiseaseCentre Hospitalier Universitaire Vaudois and University of LausanneLausanneSwitzerland
  5. 5.Community PharmacyPharmacie de la Policlinique Médicale UniversitaireLausanneSwitzerland

Personalised recommendations