A qualitative study of underutilization of the AIDS drug assistance program

J Assoc Nurses AIDS Care. Sep-Oct 2014;25(5):392-404. doi: 10.1016/j.jana.2013.11.003. Epub 2014 Feb 4.


In our previous work, we demonstrated underutilization of the AIDS Drug Assistance Program (ADAP) at an HIV clinic in Alabama. In order to understand barriers and facilitators to utilization of ADAP, we conducted focus groups of ADAP enrollees. Focus groups were stratified by sex, race, and historical medication possession ratio as a measure of program utilization. We grouped factors according to the social-ecological model. We found that multiple levels of influence, including patient and clinic-related factors, influenced utilization of antiretroviral medications. Patients introduced issues that illustrated high-priority needs for ADAP policy and implementation, suggesting that in order to improve ADAP utilization, the following issues must be addressed: patient transportation, ADAP medication refill schedules and procedures, mailing of medications, and the ADAP recertification process. These findings can inform a strategy of approaches to improve ADAP utilization, which may have widespread implications for ADAP programs across the United States.

Keywords: AIDS Drug Assistance Program; policy; qualitative; social-ecological model; utilization.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alabama
  • Anti-HIV Agents / economics*
  • Anti-HIV Agents / therapeutic use
  • Attitude of Health Personnel
  • Female
  • Focus Groups
  • HIV Infections / drug therapy*
  • Health Policy
  • Health Services Accessibility
  • Humans
  • Insurance, Pharmaceutical Services / statistics & numerical data*
  • Logistic Models
  • Male
  • Medical Assistance / statistics & numerical data*
  • Qualitative Research
  • Social Stigma
  • Social Support
  • Socioeconomic Factors
  • United States


  • Anti-HIV Agents