Page 170 - HIV/AIDS Guidelines

Table 12. Strategies to Improve Adherence to Antiretroviral Therapy

Strategies Examples

Use a multidisciplinary team approach • Nurses, social workers, pharmacists, and medications managers
Provide an accessible, trusting health care team

Establish a trusting relationship with the patient
Establish patient readiness to start ART
Assess and simplify the regimen, if possible

Identify potential barriers to adherence before starting • Psychosocial issues
ART • Active substance abuse or at high risk of relapse
• Low literacy
• Low numeracy
• Busy daily schedule and/or travel away from home
• Nondisclosure of HIV diagnosis
• Skepticism about ART
• Lack of prescription drug coverage
• Lack of continuous access to medications

Provide resources for the patient • Referrals for mental health and/or substance abuse treatment
• Resources to obtain prescription drug coverage
• Pillboxes

Involve the patient in ARV regimen selection • For each option, review regimen potency, potential side effects, dosing
frequency, pill burden, storage requirements, food requirements, and
consequences of nonadherence

Assess adherence at every clinic visit • Use a simple checklist that the patient can complete in the waiting room
• Ensure that other members of the health care team also assess adherence
• Ask the patient open-ended questions (e.g., In the last 3 days, please tell
me how you took your medicines.)

Identify the type of nonadherence • Failure to fill the prescription(s)
• Failure to take the right dose(s) at the right time(s)
• Nonadherence to food requirements

Identify reasons for nonadherence • Adverse effects from medications
• Complexity of regimen (pill burden, dosing frequency, etc.)
• Difficulty swallowing large pills
• Forgetfulness
• Failure to understand dosing instructions
• Inadequate understanding of drug resistance and its relationship to
adherence
• Pill fatigue
• Other potential barriers

If resources allow, select from among available • See http://www.cdc.gov/hiv/topics/research/prs/ma-good-evidence-
effective interventions interventions.htm

Key to Abbreviations: ART = antiretroviral therapy; ARV = antiretroviral

Guidelines for the Use of Antiretroviral Agents in Pediatric Infection K-4

Downloaded from http://aidsinfo.nih.gov/guidelines on 12/8/2012 EST.