Does Antiretroviral Therapy Packaging Matter? Perceptions and Preferences of Antiretroviral Therapy Packaging for People Living with HIV in Northern Tanzania.
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2020-01-23
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Abstract
Introduction
Despite improvements in treatment (eg, reduction in pill intake), antiretroviral therapy (ART) is dispensed in socially inefficient and uneconomical packaging. To make pills less conspicuous and decrease the risk of being stigmatized, people living with HIV (PLWH) often engage in self-repackaging - the practice of transferring ART from original packaging to alternative containers. This behavior has been associated with ART nonadherence and failure to achieve viral load suppression. While much of the literature on ART packaging has centered around medication adherence, patients stated preferences for ART packaging and packaging attributes that influence the observed ART nonadherence are understudied.Methods
We conducted a qualitative study to elucidate perceptions of ART packaging among PLWH at two large referral hospitals in Northern Tanzania. Interviews were conducted until thematic saturation was reached. Interviews were audio-recorded, transcribed and coded.Results
Of the 16 participants whose data were used in the final analysis, a majority were between 36 and 55 years of age (Mean 45.5 years SD: 11.1), had primary-level education (n=11, 68.8%), were self-employed (n=9, 56.3%), reported that they had self-repacked ART (n=14, 88%), and were taking ART for more than 6 years (n=11, 68.8%). Participants identified three attributes of ART packaging that increased anticipated HIV stigma and prompted self-repackaging, including visual identification, bulkiness, and the rattling noise produced by ART pill bottles.Conclusion
Given the drastic reduction in the number of pills required for HIV treatment, there is an opportunity to not only assess the cost-effectiveness of innovative ART packaging but also evaluate the acceptability of such packaging among PLWH in order to address stigma and improve ART adherence.Type
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Muiruri, Charles, Shelley A Jazowski, Seleman K Semvua, Francis P Karia, Brandon A Knettel, Leah L Zullig, Habib O Ramadhani, Blandina T Mmbaga, et al. (2020). Does Antiretroviral Therapy Packaging Matter? Perceptions and Preferences of Antiretroviral Therapy Packaging for People Living with HIV in Northern Tanzania. Patient preference and adherence, 14. pp. 153–161. 10.2147/ppa.s238759 Retrieved from https://hdl.handle.net/10161/25535.
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Scholars@Duke
Charles Muiruri
Dr. Muiruri is a health services researcher, Assistant Professor in the Duke Department of Population Health Sciences, Assistant Research Professor in the Global Health Institute, and Adjunct lecturer at the Kilimanjaro Christian Medical University College, Moshi Tanzania.
Broadly, his research seeks to improve the quality of healthcare and reduce disparities for persons with multiple chronic conditions both in and outside the United States. His current work focuses on prevention of nonAIDS comorbidities among people living with HIV. His current projects funded by NIAID, NHLBI and NIMHD focus on improving the quality of cardiovascular disease prevention and care among people living with HIV in North Carolina and Tanzania.
Areas of Expertise: Mixed methods, Qualitative methods, Applied Econometrics in Health services Research, Preference research, Implementation Science, Global Health, Health Policy
Brandon Knettel
Brandon Knettel, Ph.D. is Associate Director of the Duke Center for Global Mental Health and an Associate Professor with a primary appointment in the Duke University School of Nursing and a secondary appointment in the Duke Global Health Institute. His areas of specialization are global mental health and health behavior, with a focus on care engagement, nurse-led models of care, stigma reduction, and mental health support for people living with HIV. At DGHI, he teaches a course in Global Mental Health for the Master's of Science in Global Health program.
Dr. Knettel’s international projects are primarily located in Moshi, Tanzania, where he completed a one-year VECD Fogarty Global Health Fellowship to evaluate a community health worker program for HIV care engagement. He also completed a NIMH K08 Career Development Award to develop a brief telehealth counseling intervention to address suicidal ideation and improve care engagement among people living with HIV and was co-PI of a DGHI pilot grant to improve the understanding of cancer-related stigma in Tanzania.
Leah L Zullig
Leah L. Zullig, PhD, MPH is a health services researcher and implementation scientist whose work focuses on accelerating the adoption of evidence-based practices to improve healthcare delivery and population health. She is a Professor in the Duke University Department of Population Health Sciences and an investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham Veterans Affairs Health Care System.
Dr. Zullig is a recognized leader in implementation science. She directs INTERACT, the Implementation Science Research Collaborative, which fosters interdisciplinary collaborations across Duke University and with external partners to accelerate the translation of research into practice. She also leads the Dissemination and Implementation Catalyst within Duke's Clinical and Translational Science Award (CTSA) program and serves as Co-Leader of the Duke Cancer Institute's Cancer Prevention and Control Research Program.
Dr. Zullig's research spans three interconnected areas: improving the quality and delivery of cancer care; advancing cancer survivorship and chronic disease management; and enhancing medication adherence. Across these domains, she applies implementation science methods to develop, evaluate, and scale evidence-based interventions that promote equitable, high-quality care across diverse healthcare settings. Her research is characterized by strong partnerships with healthcare systems, ensuring that findings extend beyond publication to inform clinical practice, health system transformation, and policy.
Dr. Zullig has authored more than 200 peer-reviewed publications and has established a national reputation for leading pragmatic, health system-embedded research that improves patient outcomes and advances the science of implementation.
Dr. Zullig earned her Bachelor of Science in Health Promotion, Master of Public Health in Public Health Administration, and PhD in Health Policy.
John Alexander Bartlett
My clinical investigation is focused on the pathogenesis and treatment of HIV infection and its complications, especially in resource-limited settings.
Key Words: HIV infection, AIDS, treatment strategies, treatment failure, co-infections, resource-limited settings
Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
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