British HIV Association (BHIVA)/British Association for Sexual Health and HIV (BASHH) guidelines on provision of adherence support to individuals receiving antiretroviral therapy (2003)

Abstract

SummaryThe widespread use of highly active antiretroviral therapy (HAART) has dramatically reduced HIV-associated morbidity and mortality where treatment has been made available. Very high levels of adherence to HAART are a prerequisite for a successful virological and immunological response. Low adherence increases the risk of treatment failure and disease progression. It is also likely to lead to further transmission of resistant viruses, and to have a negative impact on the cost effectiveness of HAART. Low adherence is difficult to predict, and this has two key implications for service provision. Firstly, HAART should not be withheld on the basis of assumptions about adherence. Secondly, support with adherence should be provided to all patients prescribed HAART. Our understanding of barriers to and enablers of high adherence, and the evidence base regarding effective interventions, is limited. Meta-analysis of randomized controlled trials available from the general literature suggests multiple interventions are required to maintain high adherence to chronic therapy. This document recommends a series of measures for adoption within HIV clinical care settings, based on evaluation of existing data. High adherence is a process, not a single event, and therefore adherence support must be integrated into clinical follow up. Every prescribing unit should have a written policy on provision of adherence support, and ensure that staff are appropriately trained to make delivery of such services possible.

Factors Associated with Antiretroviral Treatment Adherence among Adult Patients in Wolaita Soddo Hospital

“…The self reported dose adherence rate found by this study was 87.5%. It was less than the finding in Jimma University Specialized hospital and study in Kenya, Mombassa where self reported adherence was 93.4% and greater than 95%, respectively [12,19]. Adherence rate in most developed countries, ranged from 50% to 70% [1,18].…”

“…This finding suggests that lack of adequate diet influenced the qualitative aspect of ART adherence as most respondents managed their inadequate diet by taking drugs even when they didn't have diet. Inadequate diet to take with ART was significantly associated with dose adherence; similarly a study in South Africa showed that food supplement and higher CD4 cell count have statistical association with adherence [19].…”

Factors Associated with Suboptimal Antiretroviral Therapy Adherence to Dose, Schedule, and Dietary Instructions

“…below 95% adherence) is strongly associated with diminished viral suppression (Bartlett, 2002;Paterson et al, 2000), increased risk of viral mutation, and the emergence of viral resistance (Poppa et al, 2004). Suboptimal adherence to ART can lead to the development of resistant viral strains that can be transmitted to others (Poppa et al, 2004). Research has identified a number of medication and psychosocial factors associated with suboptimal adherence to dose.…”

Doctor-patient concordance during HIV treatment switching decision-making

“…The British HIV Association/British Association for Sexual Health and HIV guidelines on provision of adherence support stress the need to offer an individualized approach sensitive to patients' needs [7,8]. Adherence is likely to be enhanced if the medical regimen is understood by patients and fits their lifestyle and beliefs, and if their concerns have been addressed [9,10].…”