Refocusing the focus on adherence to antiretroviral therapy using a community-based participatory research approach

  • Author / Creator
    Lefebvre, Megan, Elizabeth
  • Adherence to antiretroviral therapy is critical to treatment success. Using an epidemiological and community-based participatory research approach, my thesis reports on two papers related to antiretroviral therapy success (and subsequent failure). My thesis also includes a third paper which discusses an effective and appropriate knowledge translation plan. In the first paper, I used logistic regression to compare initial treatment success among treatment-naïve HIV-positive individuals cared for at the Northern Alberta HIV Program. For individuals achieving initial treatment success, I used survival analysis to determine the probability of subsequent treatment failure. Results showed that compared to Canadian-born, non-Aboriginal patients, the odds of achieving initial treatment success were similar for foreign-born patients and significantly lower for Canadian-born Aboriginal patients. Of those individuals who achieved initial treatment success, compared to Canadian-born, non-Aboriginal patients, foreign-born and Canadian-born Aboriginal patients had similar rates of treatment failure. I concluded that HIV clinicians, researchers, HIV community services organizations, and HIV-positive individuals, work together to better understand adherence to antiretroviral therapy. As such, my second study used focused ethnography to understand, from the perspective of HIV-positive individuals who maintain adherence to their antiretroviral therapy, reasons for antiretroviral therapy success. I conducted one-on-one interviews with 14 individuals with “chaotic” lives (e.g., unstable housing, substance use, involvement in the sex trade, and incarceration) but who nonetheless had demonstrated sustained adherence to antiretroviral therapy and involved a ‘grand tour question’; “what is your secret for taking your HIV medication all the time?”. My data revealed “control” as the cornerstone for maintaining adherence. Participants felt that while they had little or no control over their life circumstances they recognized that, by taking their ART, they could have control over their HIV treatment, which enabled them to make additional positive life changes. The third paper is a commentary describing my knowledge translation plan (a video and peer-educators) to move the knowledge generated from the previous project into action. My evaluation of this knowledge translation plan emphasized the importance of “humanizing” the experience of ART adherence; peer-educators became local HIV medication “celebrities” to their peers. Together, the findings from this thesis consider antiretroviral therapy in a new light by emphasizing success; clinicians must be aware of the extent to which individuals believe they can control their HIV treatment and incorporate support for this sense of control in efforts to improve adherence.

  • Subjects / Keywords
  • Graduation date
    Fall 2014
  • Type of Item
  • Degree
    Doctor of Philosophy
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
  • Institution
    University of Alberta
  • Degree level
  • Department
  • Specialization
    • Epidemiology
  • Supervisor / co-supervisor and their department(s)
  • Examining committee members and their departments
    • Mayan, Maria (Extension)
    • Simpson, Scot (Pharmacy)
    • Flicker, Sarah (Environmental studies)
    • Houston, Stan (Medicine & Dentistry)
    • Hughes, Christine (Pharmacy)
    • Saunders, L Duncan (School of Public Health)
    • Yasui, Yutaka (School of Public Health)