Information, Education and effective communication talored to their needs and belief system remains the best strategy to be adopted in the improvement of patients' lives

From your question, you indicate that adherence to HIV and AIDS medicines in Nigeria is high and there are some factors that have been shown to contribute to that, i believe you want to establish which factors may be adapted into strategies for sustained high adherence.

Since you want to conduct a qualitative research, interview with the patients, health care providers, managers, caregivers and community organization representatives (such as support groups and home based care groups)  may be the way to go. You could use semi-structured questionnaires and focused group discussions and your questions should include some of the factors identified to result in high adherence and seek from the participants what they should be done. In your interviews you should have representation in terms of gender, age and if possible, duration on therapy. 

Despite optimal adherence, depression is hampering the success of antiretroviral treatment. In presence of depression, there is reduced quality of life, increased morbidity and mortality and poorer immunological response to antiretropvirals despite optimal viral load suppression. Positive spiritual coping is associated with resilience to depression. I suggest screening for depression, spirituality and quality of life, This does not take long using standardized questionnaires (BDI, Spreu-K, WHO-QoL bref).

The first step, I believe is to structure your questionnaires to extract vital information on the reasons why people on these medications do not adhere to their medication. Collation of these reasons will then be key to addressing this issue and designing an intervention to that effect.

Despite optimal adherence among PLWHA, there are many aspects affecting patient's life. These may be seen from various perspectives including;

1. Social aspects dealing with stigma and discrimination

2. Preventive aspects-status denial

3. various domains of quality of life etc.

I agree to the suggestion that perhaps a qualitative methodology in findings areas to be addressed, would be more appropriate. However it may reflect perspectives of various stakeholders including patients.

All the best.

Regards

1. I am conducting a qualitative study on HIV/AIDS medication adherence and compliance and seek contributions on how to gather relevant information.

You can gather relevant information through one-to-one interviews and focus group discussions (FGDs) with relevant stakeholders who might include: patients, health care providers, managers, caregivers and community organization representatives as suggested by Joyce Kgatlwane. However, you have to be clear in the first instance on what exactly you want to find out about HIV/AIDS medication adherence and compliance. After clearly defining your question, scope the already available literature to find out what has already been done concerning your questions of interest- this could lead to redefining your questions in light of what your find (e.g. adding more questions, or changing your questions in-order to address an apparent gap in literature with regards to your topic of interest). It is usually an iterative process until you finally get your main question(s) right. Having a clear question(s) and scoping the literature will also help you with defining which aspect to explore during the interviews and FGDs so as to address the main question(s).

2. What strategies can be adopted to improve patients' lives since HIV/AIDS medication adherence in Nigeria has been high due to identified factors?

This is a very broad question which goes beyond health care or health services. I think you first have to have an idea of what problems these patients face. For example, medication adherence could be high, but are their HIV related health outcomes good (i.e. viral suppression, CD4 count, disease progression, death due to HIV etc)? If not, why? If their HIV related health outcomes are good, how about other non-HIV related health outcomes, quality of life, and even other non-health outcomes such as socio-economic outcomes (stigma, employment etc). After understanding what the issues are and why (probably using qualitative and quantitative research methods, as well as literature reviews), then you can go to literature to find out if there are any proven effective or promising approaches that can be used to address those issues to improve patient’s lives. Again ‘improving patient’s lives’ is very broad- might need to think about in what specific way(s).

I hope this helps.

Hi,  the strategies varies for each identified factors. As for as treatment is concerned, the best possible strategy could be strict adherence of ant retro viral therapy (ART). I have written a paper 'Optimizing Antiretroviral Therapy (ART) adherence' which may be helpful for you.

And for other factors, its better to enlist the factors and with some empiricism you can derive strategies.

All the best.

I think norren is raising a very important factor of the HIV/AIDS- and non-HIV related outcomes. Also, what is important is how adherence is measured since unlike with diabetes where  HbA1c may be used as measure of adherence to antidiabetic medicines over 3 months, there is none for HIV and AIDS . So the best thing is to also check whether high adherence levels correlate with viral suppression and clinical outcomes. Once high adherence levels have been verified, them you could collate the factors that have been shown to facilitate good adherence and use those to explore what could be adopted as strategies.

My other comment is on the use of adherence and compliance. I know we sometimes use the two terms interchangeably but really by definition, they are totally different and most people have adopted adherence over compliance.

Patients lives improve when sensitive HIV/AIDS drugs are adhered to by patients. We should make sure that we administer these drugs based on sensitivity tests in Nigeria as in other developed countries.. Development of drug resistance will negate advances and achievements made  in HIV prevention and care.Other strategies include early HIV diagnosis and treatment irrespective of CD4 count and viral load  levels and prompt treatment of OIs, Improvement of patients economic status will also improve their lives.