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.