Community Based Service Provider Perspectives on ART Adherence and HIV-Positive Injection Drug Users Enrolled in Methadone Maintenance

Abstract

People living with HIV and who use injection drugs (IDUs) often face difficult life circumstances and comorbidities. Antiretroviral therapy (ART) is the only treatment available for HIV and long-term adherence is challenging. Methadone maintenance therapy (MMT) has been shown to improve health outcomes and medication adherence in IDUs living with HIV. The objective of this study was to gain an in-depth understanding of the barriers and facilitators that affect ART adherence from the perspective of service providers who work with HIV-positive IDUs. Eleven service providers were recruited from organizations in Halifax, Nova Scotia who work with people living with HIV and IDUs. They were interviewed about their perspectives on the structural and contextual facilitators and barriers that they and their clients encounter on a daily basis. Interviews were transcribed, coded, and analyzed using a grounded theory approach. Seven themes were identified: program support, resources, stigma, systemic barriers and IDU lifestyle, service availability, ART and MMT adherence, and policy. The organizations providing are generally underfunded and have limited resources. When these factors are combined with the clients’ difficult life circumstances, they may not receive adequate support and therefore face worse health outcomes. This research suggests that the population of HIV-positive IDUs in Halifax needs more easily available access to services for housing, transportation, and addiction treatment.