ID: HR19-602
Presenting author: Umar Riaz
Umar Riaz, Muna Handule
The HIV epidemic in Pakistan is injecting drug use driven with a prevalence of 37.8%. Adherence to ART medication reduces morbidity and mortality among HIV positive PWID. Since OST is not allowed in Pakistan, a voluntary residential facility that combines treatment for opioid dependence with HIV treatment adherence support for HIV positive PWID was established in 2014. Annually 1800 HIV positive PWID initiate ART at the unit. Despite all efforts a proportion (20-25%) of PWID are found to be non-adherent to ART in follow up.
In 2018 a comprehensive study was conducted to identify factors leading towards Non-adherence to ART among PWIDs. The key objectives of the study were to find out the contributing factors leading to non-adherence and establishing methods to reduce the rate of non-adherence.
The sample for the study was drawn from four selected districts having a significant ratio of non-adherent PWID from the total thirty districts. Structured individual interviews were carried out with 150 clients known to be non-adherent on ART. The main reason for not continuing ART described by 53% respondents was that they relapsed to drug use and majority of them considered it harmful to take ARVs along side other drugs. Other reasons include side effects of ARVs and/or change of regimen to deal with the side effects (21%); Dislocation from city of origin or having been jailed (17%); chaotic living conditions on the streets and lack of social support (8%). Additionally, strict conditions for issuance of medicines at the ART Centre, travel difficulties and non cooperative attitude by the ART centres staff was mentioned as a barrier to ART Adherence by 26% of the respondents.
The findings suggest that there is an immense need for advocacy for OST at the national level and sensitizing Provincial health departments and other concerned stakeholders to ensure PWID friendly services at the ART centres.