Page 169 - HIV/AIDS Guidelines

the Compendium of Evidence-Based HIV Behavioral Interventions that includes eight medication adherence
behavioral interventions identified from the scientific literature published or in press from January 1996
through December 2009. For descriptions of the interventions, see: http://www.cdc.gov/hiv/topics/
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research/prs/ma-good-evidence-interventions.htm. Since these reviews have been conducted, additional
evidence also has accumulated regarding the efficacy and benefits of motivational interviewing. 23
In summary, effective adherence interventions vary in their modality and duration, providing clinics,
providers, and patients with options to suit a range of needs and settings. Some effective interventions
identified include multiple nurse home visits, five-session group intervention, pager messaging, and couples-
based interventions. Substance abuse therapy and strengthening social support also can improve adherence.
All health care team members, including nurses, nurse practitioners, pharmacists, medication managers, and
social workers, have integral roles in successful adherence programs. 24-27 Directly observed therapy (DOT)
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has been shown to be effective in provision of ART to active drug users. However, the benefits cannot be
sustained after transitioning the drug users out of the methadone clinics and halting the provision of ART by
DOT. 29

To routinely determine whether such additional adherence intervention is warranted, assessments should be
done at each clinical encounter and should be the responsibility of the entire health care team. Routine
monitoring of HIV viral load and pharmacy records are useful determinants for the need of intensified efforts.

Conclusion
Significant progress has been made regarding determinants, measurements, and interventions to improve
adherence to ART. Given the various assessment strategies and potential interventions available, the
challenge for the treatment team is to select the techniques that provide the best fit for the treatment setting,
resources available, and patient population. The complexity and the importance of adherence encourage
clinicians to continue to seek novel, patient-centered ways to improve adherence and to tailor adherence
interventions. Early detection of nonadherence and prompt intervention can reduce greatly the development
of viral resistance and the likelihood of virologic failure.

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents K-3

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