Treatment Literacy/Information needs/Adherence

Work in progress, expect frequent changes. Help and feedback is welcome. See discussion page.

Adherence

Definition

Adherence is “an engagement and accurate participation of an informed patient in a plan of care”1 It is the extent to which a person’s behavior corresponds with medical advice. The ability to consistently take the medicines at exactly or approximately the same times each day depends on the individual's frame of mind as well as the support of family members, the people around them, and the community at large. Administration of ARVs imposes constraints on the daily schedule and lifestyle and it can be difficult for individuals to adapt to these demands, especially on a long-term basis. Adherence to anti-retroviral drugs should ideally be over 95 per cent.

Why is adherence important?

Adherence to HAART (highly active antiretroviral therapy) is a major determinant of its biologic, clinical and public health outcomes:

• Poor adherence is a major cause of ARV failure: Adherence affects how well anti-HIV medications decrease the viral load. When a medication dose is skipped, even just once, the virus has the opportunity to reproduce more rapidly. Keeping HIV replication at a minimum is essential for preventing AIDS-related conditions and death. Taking anti-HIV medications correctly (adherence) increases your odds of success.
• Poor adherence is a major cause of ARV resistance and, with continuing risk behavior, transmission of resistant organisms. Skipping a dose may develop strains of HIV that are resistant to the medications taken and even to the medications not yet taken. This may leave fewer treatment options if the treatment regimens need to be changed in the future. Because drug-resistant strains can be transmitted to others, engaging in risky behavior can have especially serious consequences. Although there are many different anti-HIV medications and treatment regimens, studies show that the first regimen has the best chance for long-term success. Taking anti-HIV medications correctly (adherence) increases the odds of success.

Materials

• 

  

  Boehringer Ingelheim’s Antiretroviral Agents Adult Dosage Card with symbols for illiterate or low literate audience (2007 edition)- page 1
  

  

  Boehringer Ingelheim’s Antiretroviral Agents Adult Dosage Card with symbols for illiterate or low literate audience (2007 edition)- page 2

Web Resources

WHO Antiretroviral therapy in adults & adolescents

Some techniques have been shown to improve adherence such as: Medication manager, Peer support, Electronic reminders, Home visiting, Modified DOT (directly observed therapy)… Such a combined approach to adherence works best.

Adherence improvement strategies

For more resources on adherence improvement strategies search "adherence" here (abstracts search)


1- Rabkin M, El-Sadr and W, Abrahams E (2005) MTCT-Plus Clinical Manual, p. 12, Mailman School of Public Health Columbia University, New York Also available at http://www.columbia-icap.org/resources/supporttools/index.html