Conceptualizing antiretroviral adherence in Beijing, China

Abstract

International health experts agree that China is on the verge of an AIDS crisis. In response, the Chinese government initiated the “Four Frees and One Care” policy in 2003 to decrease economic barriers and increase access to antiretroviral therapies for people with HIV. However, long-term treatment success requires not only access, but high rates of medication adherence. This qualitative interview study with 29 persons receiving HIV care at Beijing's Ditan Hospital identified barriers to and facilitators of medication adherence. The interviews were guided by an a priori conceptual model of adherence with four components: access, knowledge about medications, motivation, and proximal cues to action. Barriers to adherence were related to stigma and fear of discrimination; the medications themselves (including side-effects and complicated dosing regimens); and other economic issues (i.e. costs of transportation, lab tests and hospitalizations). Facilitators included participants’ strong will to live, use of electronic reminders and family support. These results support the conceptual model and suggest that successful interventions must minimize stigma as it negatively affects all components of the model for adherence.

Keywords:

• antiretroviral adherence
• qualitative research
• China
• conceptual models

Acknowledgements

This study was supported by R34-MH074364 from the US National Institute of Mental Health (NIMH) to Dr. Simoni. The views expressed are those of the authors and do not necessarily reflect the institutional opinions or positions of NIMH, the University of Washington, the China CDC or Ditan Hospital. We would like to acknowledge and thank Li Se, Wenhui Lun, Kerong Wang, Xiaojing Wang, Yan Wu and Chunhui Wang for conducting the interviews and Amiel Dan Ying, Chunhui Wang and Chengshi Shiu for their translations of the transcripts.