Drug users and HIV-combination therapy (HAART): factors which impede or facilitate adherence.

The current highly active antiretroviral therapy (HAART), i.e., triple combination treatment including a protease inhibitor, allows for long-term suppression of HIV-replication. The intake guidelines, however, are very strict and, like many other HIV positive patients, drug users have problems in achieving good therapy compliance. As a result, the effectiveness of the medication therapy is seriously jeopardized. This qualitative study, involving in-depth interviews with 27 "hard drug" users in Amsterdam, seeks to provide better insights into the extent of adherence to HAART. In addition, factors that impede or facilitate adherence have been listed in order to develop and improve strategies. The study shows that almost half of the "hard drug" users interviewed do not adhere to the therapy. A large number of determinants for adherence were identified at the level of medication, the individual, and the environment. Many of these determinants can be influenced, which means that they can provide clues for the effective implementation of measures that may enhance effectiveness of treatment.