Optimizing adherence to antiretroviral therapy

Abstract

HIV has now become a manageable chronic disease. However, the treatment outcomes may get hampered by suboptimal adherence to ART. Adherence optimization is a concrete reality in the wake of ‘universal access’ and it is imperative to learn lessons from various studies and programmes. This review examines current literature on ART scale up, treatment outcomes of the large scale programmes and the role of adherence therein. Social, behavioural, biological and programme related factors arise in the context of ART adherence optimization. While emphasis is laid on adherence, retention of patients under the care umbrella emerges as a major challenge. An in-depth understanding of patients’ health seeking behaviour and health care delivery system may be useful in improving adherence and retention of patients in care continuum and programme. A theoretical framework to address the barriers and facilitators has been articulated to identify problematic areas in order to intervene with specific strategies. Empirically tested objective adherence measurement tools and approaches to assess adherence in clinical/ programme settings are required. Strengthening of ART programmes would include appropriate policies for manpower and task sharing, integrating traditional health sector, innovations in counselling and community support. Implications for the use of theoretical model to guide research, clinical practice, community involvement and policy as part of a human rights approach to HIV disease is suggested.

Sociodemographic and Nutritional Factors Associated with Adherence to Antiretroviral Therapy in PLWHA in Benin

“…Poor adherence meant patient not consistent with medical recommendations (>1 missed medication in a month). Patients whose medical reports pointed out one or more missed doses (forgetting of skipping medication) within a month were considered showing poor adherence [11].…”

Factors Influencing Adherence to Antiretroviral Therapy among People Living with HIV in Coastal South India

“…7,8 From the available evidence, an average rate of 24.8% of nonadherence to medication has been reported in most of the patients having chronic diseases 9 ; however, the level of ART adherence among PLHIV is higher compared to most of the other chronic diseases. 10 Previously published studies reported multiple barriers for optimal adherence to ART in both developed and developing countries, [11][12][13][14] which could be categorized into patient-related, medication-related, and health system-related factors. 15 As these barriers vary across settings, identification of the factors responsible for nonadherence to ART and contextualization of these factors will be helpful in designing and developing intervention strategies to improve adherence to ART.…”

Prevalence of Adult Attention Deficit Hyperactivity Disorder and its Correlates among Recently Diagnosed Young Adult Males with HIV

“…Adherence in our study was defined as intake of a minimum of 95% of pills which were expected to be taken by the person with HIV, which is as defined by National AIDS Control Organization, India [17]. As per existing literature, HIV associated neurocognitive deficits increase the risk of non-adherence in HIV.…”