OBJECTIVES

With increased availability of safe antiretroviral therapy (ART) in recent years, achieving optimal adherence and patient retention is becoming the biggest challenge in the people living with HIV (PLWH). Care retention is influenced by several socio-economic and socio-cultural factors. COVID-19 related measures that restrict movement may negatively impact access to HIV care and treatment. Therefore, we aim to explore barriers and facilitators to adherence to ART among PLWH in Pakistan during COVID-19 pandemic.

METHODS

Semi-structured interviews were conducted among 18 PLWH from November 2020 to February 2021 in local language (Urdu). Interviews were audio recorded and a bilingual expert (English, Urdu) transcribed verbatim, coded for themes, sub-themes and analyzed using phenomenology approach for thematic content analysis.

RESULTS

Stigma and discrimination, fear of disclosure of HIV, economic constraints, forgetfulness, religion (Ramadan, spiritual healing), adverse drug reactions, lack of social support, alternative therapies, fear of limited care of COVID-19 infection due to HIV status and COVID-19 lock-down were identified as barriers affecting the retention in HIV care. While positive social support, family responsibilities, use of reminders, beneficial impact of ART, telephone consultations, courier delivery and long-term delivery of drugs during COVID-19 were identified as facilitators of HIV retention.

CONCLUSIONS

Improving adherence and retention requires the integration of enhanced access to treatment with improved employment and social support. Healthcare providers need to be supported to better equip patients with ART problems. Cooperation between different organizations is needed to facilitate patient retention in HIV care and to improve the clinical outcomes of PLWH. There is also a need to disseminate HIV and COVID-19 information to improve HIV stigma knowledge among families and communities.