Allocating HIV treatment to the adherent: a qualitative study of patient perceptions of their HIV care in the Dominican Republic.

Background. The Dominican Republic (DR) has provided free antiretrovirals (ARVs) since 2004. Little is known about adherence to ARV regimens in the DR. Methods. We audio-recorded 53 HIV care visits at a hospital-based clinic in the DR, conducted post-visit interviews with each patient, and observed clinic policies and practices. Results. Scaled measures showed uniformly positive patient ratings of physician care and strong motivation for ARV adherence. However, it is clinic policy to suspend ARV treatment for patients believed to be non-adherent. This policy limited our study population, preventing us from talking to patients struggling with medication adherence. Clinical interactions featured little or no psychosocial content and patients did not consider physicians responsible for adherence counseling or problem solving. Discussion. Patients excluded from treatment may be those facing the greatest barriers to adherence, such as mental health and substance use disorders, and may be at risk of transmitting the virus.