SHARING LIFE SKILLS =
Accepting Treatment Adherence
What does adherence mean?
- Adherence means taking doses of drugs and sticking to the treatment plan – or ‘treatment regimen’ - exactly as prescribed.
- Adherence means taking the correct dose of drugs, at the correct time and in the correct way (for example, with the right type of food or fluid, and before or after a meal).
- Adherence also involves looking after drugs to make sure that they are effective and safe to use.
Why is it important for a person with HIV to adhere to ARV treatment?
- If ARV treatment is used correctly, it can improve a person’s health and quality of life and enable them to live for a long time.
- If adherence is very good, the amount of HIV in a person’s body will reduce very quickly after a few weeks or months. This allows their immune system to start to recover, so that illness is reduced and health is regained.
- A very high level of adherence (at least 95%) is necessary for ARV treatment to work effectively. Missing even a few doses of drugs can cause treatment to fail and opportunistic infections or drug resistance to develop.
What happens if a person’s adherence to ARV treatment is not good enough?
- Failure to adhere to ARV treatment might involve a person:
- Missing one or two doses of drugs occasionally.
- Stopping the treatment completely.
- Taking smaller doses of drugs than the amount prescribed. This might be because they are worried about side effects, lack money to pay for more drugs or are sharing treatment with another person.
- Poor adherence to ARV treatment allows a person’s levels of HIV to stay high and their immune system to stay weak. It means that they face an increased risk of severe illness, more time in hospital and early death.
- Poor adherence can also cause the virus to become resistant to ARVs. This means that the treatment stops working and there is more risk of the person becoming ill. Drug resistant HIV can be transmitted to other people, increasing their risk of illness and making their treatment difficult.
- If treatment fails or the virus becomes resistant, it is necessary to change to a different set of drugs (called ‘second-line’ drugs) for combination therapy or highly active anti-retroviral therapy (HAART). These drugs are often more expensive, the regimen will be more complicated and, as a result, it is more difficult to adhere to them.
Why might a person fail to adhere to ARV treatment?
- Most people – especially those living with a chronic health problem – miss some doses of their drugs sometimes.
- Some of the common reasons why a person with HIV misses a dose of ARVs include: forgetting; being busy; falling asleep; being depressed; and being away from home and out of the usual routine.
- There are many reasons why a person might have difficulty with their ARV treatment and, as a result, fail to adhere to it or decide to stop it. Reasons include: worries about side effects; finding the regimen too complicated, such as too many pills at too many different times; difficulties fitting pill-taking into family and work life; being tired of taking long-term treatment; or having strong anti-treatment health beliefs.
- If a person wants to stop treatment, they must discuss it fully with their doctor before making any final decision.
What can help a person to adhere to ARV treatment?
Ways of helping a person with adherence include:
- Involving the person who has to take treatment in decisions about their treatment.
- Having a good relationship between the person on treatment and their treatment provider.
- Finding out what beliefs a person has about HIV and ARV treatment, discussing them and correcting any false information. This might involve addressing specific issues, such as someone’s lack of trust in medication or beliefs that ARVs are poisonous.
- Providing clear and accurate information about HIV and ARVs that is appropriate for a person’s specific needs. This includes: what treatment can and cannot do; what to do about side effects; what to do to ensure adherence and prevent drug resistance; and what happens if treatment has to be changed.
- Providing a person with access to counselling and support from health workers and other treatment supporters.
- Regularly monitoring the progress of the treatment - through clinical check-ups and asking specific questions about adherence.
- Assessing and doing something about the person’s psychosocial concerns. These might include: stress; depression; drug and alcohol use; food; housing; childcare; lack of disclosure of HIV status; and stigma and discrimination.
- Involving a wide range of people – such as family, friends, other people with HIV and community leaders – in supporting a person to adhere to their treatment.
- Providing opportunities for a person to share their experiences with other people who are taking ARVs successfully. This might be through a ‘buddy’ system or a self-help group.
- Making the treatment regimen as simple as possible. For example, where possible, reducing the number of pills and linking doses to a person’s daily routine.
- Providing methods to help a person remember their doses. These might include diaries, charts, alarms, text messages, emails or pill boxes.
What can help a person who has difficulty with adherence to ARV treatment?
- Having a non-judgemental approach and accepting that almost everyone misses doses of drugs sometimes.
- Assessing and building a person’s overall motivation for treatment.
- Checking a person’s adherence by asking specific but open questions such as: “In the last month, how many doses do you think you missed?”
- Clarifying and checking a person’s understanding of their drug regimen.
- Addressing a person’s patterns of non-adherence. For example, looking at whether non-adherence is associated with particular social situations, behaviours or thoughts.
- Providing a person with additional support when needed – to help them remember their doses, talk about their experiences and encourage them to continue their treatment.
Key points on supporting adherence to ARV treatment?
- Integrate adherence monitoring and support into the continuum of care, support, treatment and prevention for a person with HIV.
- Provide adherence support over the long term, not just at the beginning of treatment.
- Provide ongoing training and support for health workers and others involved in adherence support.
- Develop a written adherence support policy for health workers and others supporting people with HIV on ARV treatment.
- Adapt ways of providing adherence support to individuals and their changing circumstances.
Research courtesy the International HIV AIDS Alliance
Supporting Community Action in Developing Countries
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