Table 2.

Pharmacists’ strategies to addressing barriers to antiretroviral adherence

Patient-specific barriers	Therapy-related factors	Structural level barriers
Cognitive factors: (1) Educated patients on integrating medication dosing and handling into daily routine. (2) Provided adherence reminder and support tools. (3) Enrolled patients in automatic prescription refill programs. (4) Made follow-up phone calls. (5) Addressed patient health misconceptions. (6) Scheduled doses with patient.	Adverse effects: (1) Provided medication-specific education on nature and duration of adverse effects. (2) Managed adverse effects with over-the-counter medications. (3) Identified medications with tolerable adverse effects. (4) Counseled patients to consult their physician about medication changes.	Strained patient–provider relationships: (1) Intervened in strained provider relationships. (2) Made patient referrals to other providers.
Health literacy–related factors: (1) Discussed health treatment relationships. (2) Provided patient-specific medication-related information. (3) Provided tailored medication-specific education. (4) Demonstrated pill taking.	Intolerable medications: (1) Recommended formulation substitutions for improved tolerability and administration. (2) Worked with patients and physicians to tailor regimens for tolerability and ease of administration.	Depersonalized health care system: Established and maintained relationships with patients.
Lack of social support: (1) Referred patients to HIV-related social services and social networks. (2) Counseled patients to enlist social support. (3) Provided emotional and informational support.	Polypharmacy: Sorted and reconciled patient medications, and developed a single medication list.
Psychological, mental health and substance abuse: (1) Collaborated with other health care providers. (2) Educated patients on harm reduction strategies and the effects of substance abuse.	Unaddressed patient concerns: Established pharmacy hotline, accessible to patients at all times.
Economic-related factors: (1) Referred to AIDS Drug Assistance Program. (2) Physically delivered medications. (3) Waived copays, provided manufacturer coupons. (4) Collaborated with providers to address patient needs.