Table 1.

Barriers to, and facilitators of, medication adherence for persons with HIV who use methamphetamine

Coded theme	Example of coded text
Barriers to ART adherence
1. Effects of methamphetamine use
a. Planned non-adherence	“For me it’s a choice. I decided not to take it [my medication] […] I knew from the very beginning, before I started getting high, I’m not going to take my meds today so that would not be a worry through the high, through the process. I’d just be like, my time, my party, and this is aside from all that.” “I see my meds, and I don’t forget it. But it’s like, do I take them and ruin my high? Screw it.”
b. Unplanned non-adherence	“My biggest problem was losing track of time, you know, and so I would have them, but I may take it, you know, 12 hours and then 36 hours and that kind of deal […] It was just very sloppy.” “Well, I’m always aware of the importance of taking my meds, but there is time when time gets lost, and at the end of the week or end of the month, you realize you sill have a lot of pills left!”
2. Misguided beliefs about medication adherence	“And then they said, ‘Well, if you miss one dose you are totally screwed,’ and that message started coming across and that is when I decided I would stop taking them until I could get sober because I didn’t want to become resistant.”
3. Memory and Planning Difficulties	“Just recently, I don’t remember taking it [medication], but I’m scared to take it again. That was a really big deal for me.”
4. Social barriers and stigma	“There have been situations where I meet a guy online, wherever, and I tell them that I am [HIV] positive, and even when they come over […] I still don’t feel comfortable having my meds next to my bed. I have to put them away. Even though you know, he knows, it’s just I can’t. One thing happens, we get busy or whatever, and then I just don’t take them!”
5. Mental health issues	“It’s [adherence] also about the psych part – how I’m feeling, which is really important because my mental health has big problems for my adherence.”
Facilitators of ART adherence
1. Cognitive compensatory strategies	“For me, what has been working well with my regimen is to have it at eye level on the counter like in the hallway when I go from the bedroom to the kitchen, and I don’t forget. I know it’s there. I just open the door and grab it. I don’t need to search down or open other doors.” “I started carrying around an emergency thing with me in my backpack, so if I did forget it and I’m out and about and I’m not going to be home until 3 or 4 or whatever, it’s already in there.” “I use my watch to remind me to take them at 10:00 at night. I take them at night because my meds make me nauseous.” “The way I do my meds – I do them at certain times, and I have them laid out, and if they’re not laid out, I know I didn’t take them, and, you know, if there’s one there, then I knew I took that one. But, I have little containers that I put them in, so when I travel for that day or the next day or something, so I’ll always have them with me.”
2. Promotion of well being	“I just wanted to prove to myself that I could take my meds and use at the same time.”
3. Health care supports	“I think it’s important when a doctor provides you support medications, so when you are having diarrhea, nausea vomiting, you have access. It’s really important to understand and help your side effects. Organizers are also terrific.” “Regular contact with non-judgmental medical providers is very helpful.” “I think having somewhat regular appointments and having the blood work done is important because that was somewhat of an indicator when I wasn’t taking my meds properly or when I had stopped. Where are my T cells at? What’s going on with that? Once you drop below 100, you know, all of a sudden that has a whole set of possible problems and so that plays into my thinking.”
4. Adherence education	“You know, for me, the knowledge of knowing there are only six different types of drugs and once you burn one, you are really cutting your options. And it seems like a lot of people don’t understand how that works.”
5. Social support	“I was thinking about taking meds and things like that – if we have something called the buddy system, or just maybe have one of the nurses giving you a call everyday, saying are you taking your meds?[…] If someone just asks you, ‘Did you take your meds today,’ and you say, ‘Oh no, I forgot!” Now, you reminded them with a phone call.”