Strategies to improve HIV treatment adherence in developed countries: clinical management at the individual level

Abstract

Remarkable advances in the treatment of human immunodeficiency virus (HIV) disease have been blunted by widespread suboptimal adherence (ie, nonadherence), which has emerged as a major barrier to achieving the primary goal of antiretroviral (ARV) therapy: suppression of HIV viral load. Nonsuppressed HIV viral load is associated with drug resistance, increased morbidity and mortality, and a higher risk of person-to-person HIV transmission. For HIV-infected individuals who are failing HIV treatment due to nonadherence, becoming adherent is a life-saving behavior change. However, overcoming nonadherence is one of the most daunting challenges in the successful management of HIV disease. The purpose of this paper is to provide clinicians with a better understanding of nonadherence to ARV treatment and to review the various factors that have been associated with either adherence or nonadherence. Strategies are presented that may help the nonadherent individual become ready to take HIV medications as prescribed.

Battling the HIV/AIDS Epidemic: Triumphs and Barriers

“…Although the number of people accessing antiretroviral drugs in developed places, such as North America and western and central Europe, is significantly higher than in Africa, drug adherence remains another barrier to successful treatment of HIV . Over one‐third of HIV‐infected people in developed countries have difficulty adhering to their drug regimens, resulting in negative consequences, including development of drug resistance, nonsuppressed viral loads, and increased risk of transmission to others . Although confounding factors, such as mental illness or substance abuse, are known to impact ART adherence, the stigma associated with HIV/AIDS is cited as a major culprit of nonadherence .…”

The Value of Support Group Participation in Influencing Adherence to Antiretroviral Treatment among People Living with Human Immunodeficiency Virus (HIV)

“…These fall into broad categories including psychosocial issues, economic factors, substance abuse, co-morbidities including psychiatric disease, low health literacy, and medication-related issues. Many of these factors are modifiable with adherence enhancing interventions [3].…”

A Cross-Sectional Study of Medication Adherence Pattern and Factors Affecting the Adherence in Chronic Obstructive Pulmonary Disease

“…So, the complexity of drug regimen, concerns for side effects might affect the day-to-day activities, which might be associated with non-adherence in COPD as suggested by other studies. 11,16,39 Such kind of problems is often encountered in various other chronic diseases like diabetes, 42 Hypertension, 59 human immunedeficiency virus-acquired immune-deficiency syndrome (HIV-AIDS), 60,61 and Tuberculosis as well.…”