Where we are now and how we can improve ART adherence support in Romania

Abstract

Background: Improving adherence support (AS) to antiretroviral treatment (ART) is a priority in Romania and worldwide. Understanding current support provided in clinical practice in light of behavioral theory is essential for developing effective and sustainable interventions. We explored practitioners’ experiences of AS to assess care capacity and needs. Methods: Ten semistructured interviews were conducted with practitioners from 6 HIV centers in Romania on topics regarding adherence assessment, key determinants, interventions used, perceived influences on their AS capacity. Verbatim transcripts were analyzed via thematic analysis, using behavior change theory and evidence-based taxonomies of personal adherence determinants and intervention content. Findings: There is solid foundation for AS in Romania; services are usually delivered by experienced psychologists within multidisciplinary teams, with a high degree of intervention tailoring. AS services would benefit from adopting a more structured and focused approach to patient profiling and intervention delivery, conceptualizing and recording active intervention content using precise and standardized terminology, and monitoring intervention effectiveness. Results: Our qualitative investigation provided valuable information on improving AS, and will guide the implementation of organizational changes and practitioner training programmes.