Medication adherence among African American women living with HIV/AIDS: Social context, provider-patient relationship and learning by observation

Background: In the United States, African American women continue to be disproportionately affected by HIV-related morbidity and mortality. Efforts to address the burden of HIV/AIDS in this at-risk population need to be directed towards gaining a better understanding of the factors that influence and/or affect their care-seeking behavior and specifically their adherence to antiretroviral treatment.

Methods: A preliminary qualitative study was conducted with a sample of African American women living with HIV (n=10) using grounded theory. Using the same methodological approach, 21 health care providers – physicians, pharmacists, nurses and case managers – were also interviewed. A thematic analysis of the transcripts compared care-provider and patient perspectives on factors associated with medication adherence in the target populations.

Findings: Themes related to the process and approach in patient care perceived to enhance medication adherence included (1.) provider-patient relationship; (2.) holistic and patient-centered care; (3.) adequacy of patient education and adherence counseling; (4.) modelling adherence behavior; and (5.) motivation. A major finding was the overarching influence and significant impact of the patient’s social context on health-seeking behavior and medication adherence in this population. Two intervention strategies were proposed by patients and providers respectively – Peer educators as an integral part of the care team; and Patient Advisory Groups as a feedback mechanism to enhance effective delivery of patient care in the target population.

Conclusion: This exploratory research lays a foundation for the design of targeted interventions to improve linkage to care and enhance medication adherence in African American women living with HIV/AIDS.