Adhering to HIV therapy helps maintain suppression
Common barriers to adherence
Despite prescribing a simple regimen and other efforts to maintain patients on the HIV continuum of care, a multitude of patient-related factors can pose barriers to adherence1,2:
- Inconsistent access to medications1
- Depression and other mental illnesses1
- Neurocognitive impairment1
- Low levels of social support1,3
- Low health literacy1
- Stressful life events1,3
- Alcohol/substance use1,3
- Homelessness, poverty1
- Nondisclosure of HIV
- Financial/insurance status1,2
- Treatment fatigue1,2
Speaking to your patients on ways to improve adherence
Addressing adherence issues early on during treatment can equip your patients to take on the daily challenges of HIV. There are proven, easy-to-understand reminders and routines to help your patients stay on track.
Reminder and routine methods1,6
Linking medication to daily activities
The DHHS panel’s recommendations on adherence to the continuum of care include assessing (and reassessing) the patient’s linkage to care and adherence to antiretroviral therapy (ART) and clinic appointments; approaching patients about adherence problems in a constructive, collaborative, nonjudgmental way; and tailoring the approach to each patient’s needs or barriers to care.
Measuring retention in care should be done consistently1
Consistency measures that can be used for clinic quality assurance:
- Minimum of 2 visits at least 90 days apart over a period of 1 year
- At least 1 visit every 6 months over a period of 2 years
DHHS guidelines recommend using stigma-reducing and adherence motivators1
- Emphasizing personal benefits, like viral suppression and improved health
- According to the DHHS guidelines, suppressing the HIV viral load to <200 copies/mL with ART prevents sexual transmission of HIV, which is also called “Undetectable equals Untransmittable”, or “U=U”. Discussing U=U with patients may motivate them to share their HIV status with sexual partners. Understanding U=U may also help reduce stigma and improve adherence for patients.
People who are not adherent risk becoming resistant to medications and, therefore, may have fewer treatment options.1 Despite being on a regimen with simple administration, other common barriers to adherence can prevent patients from maintaining virologic suppression.1
DHHS, US Department of Health and Human Services; RNA, ribonucleic acid.
- Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Department of Health and Human Services. Updated January 20, 2022. Accessed January 31, 2022. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/guidelines-adult-adolescent-arv.pdf
- Burgess M, Zeuli J, Kasten M. Management of HIV/AIDS in older patients—drug/drug interactions and adherence to antiretroviral therapy. HIV AIDS (Auckl). 2015;7:251-264.
- Halkitis P, Shrem M, Zade D, Wilton L. The physical, emotional and interpersonal impact of HAART: exploring the realities of HIV seropositive individuals on combination therapy. J Health Psychol. 2005;10(3):345-358.
- Carr R, Gramling L. Stigma: a health barrier for women with HIV/AIDS. J Assoc Nurses AIDS Care. 2004;15(5):30-39.
- Stirratt M, Remien R, Smith A, et al.The role of HIV serostatus disclosure in antiretroviral medication adherence. AIDS Behav. 2006;10(5):483-493.
- Fisher J, Fisher W, Amico K, Harman J. An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol. 2006;25(4):462-473.