Strategies for Promoting Antiretroviral Therapy Adherence Among Participants at a U.S. Long-Term Care Facility for People With HIV: A Qualitative Study.

Abstract

ABSTRACT Evidence suggests that HIV antiretroviral therapy (ART) adherence is suboptimal in long-term care (LTC) settings. We studied an HIV-specialized LTC facility to understand how a person-centered care model impacts ART adherence among older adults with HIV (OAWH). We conducted semistructured, in-depth interviews with 11 OAWH and five LTC staff/clinicians asking about barriers and facilitators to ART adherence. Interviews were recorded, transcribed verbatim, and analyzed using deductive and inductive rapid analysis matrices. Three themes emerged: functional support, routines, and fostering resident autonomy, which were achieved by the facility through increased availability of prescribing authorities, highly collaborative efforts in patient care planning, and medication reconciliation that prioritized interdisciplinary communication. The significant social and personal challenges of OAWH preadmission provided context emphasizing the magnitude of improvement from nearly none to 100% ART adherence. This facility's approach may serve as the basis for demonstration projects aimed at revising procedures in non-HIV-specialized LTC facilities.