Introduction
HIV is the major cause of AIDS which is a chronic, potentially
life-threatening immunodeficiency disease
1. Thus, making those
patients more susceptible to have opportunistic infections and cancers
2.
According to the Joint United Nations Programmer on HIV/AIDS (UNAIDS)
data, the prevalence of HIV in the global world was estimated 36.9
million people, 940,000 patients of them died of AIDS-related illness in
2017. Adding to that, 66% of the cases were reported in Sub-Saharan
Africa and the vast majority of the people living with HIV disease were
located in low- and middle-income countries
3. Furthermore, 18,000
patients were living in the Middle East and North Africa
3. Apart from the
international statistics, the total number of HIV/AIDS cases were
registered in Jordan were 1,080 patients since 1986, as reported by a
health ministry official in 2014. Over the last 28 years, 65.29% of
patients had the disease via sexual intercourse, 22.68% through blood
transfusion and 2.41% by drug injection. However, a rising in new
incident cases is noticed; 54 new cases were reported in 2014
4, 92 new cases were
reported in 2015 5, and
103 new cases were reported in 2016
6.
Treatment failure is common among HIV patients
7,8.
Poor adherence was strongly associated with virological failure among
patients on ART
9,10.
HIV/AIDS patients should have an adherence level of at least 95% as a
requirement for optimizing ART and maximizing virological suppression
11.
Several factors were found to affect adherence to ART, including
psychological reactions such as depression, disappointment, hesitation,
forgetfulness, and exhaustion, perceived support, contradictory beliefs,
and environmental barriers. Moreover, medications’ side effects were
found to affect HIV patients’ adherence
12. Meanwhile,
disclosure of HIV status, social support, use of reminders, life-long
projects, counseling and education, and improved health on ART
facilitated medication adherence and retention in HIV care
13.
Forming a good patient-provider relationship can enhance adherence
14. It has been proved
in the literature that there is a paradigm shift from a ‘detached
paternalistic relationship towards a more empathetic, patient-centered
model of care’ 15. The
patient-centered model of care is the cornerstone of pharmaceutical care
16. Pharmaceutical care
is defined as” the responsible provision of drug therapy for the purpose
of achieving definite outcomes that improve a patient’s quality of
life” 16.
A new pharmaceutical care model, known as Ability-Motivation-Opportunity
(AMO) has been developed
17. In this model,
healthcare providers should have the ability to provide individualized
pharmaceutical care to each patient, as well as they should be able to
motivate the patients to reach goals with drug therapy. Finally, they
should have the proper opportunity to provide pharmaceutical care with
personal consultations, through information, communication, and learning
technologies. With this approach the results were satisfying and
assisted patients to take better care of themselves, following their
treatment, determining goals to control their disease
17. Based on the above
evidence, this research aimed to find the barriers and facilitators of
adherence to ART among HIV positive patients in Jordan and to assess
their need to pharmaceutical care servides.