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Adherence to ART

Adherence to antiretroviral treatment (ART) is required for patients to achieve sustained viral suppression.  Providers can initiate strategies that anticipate barriers to adherence and work with patients to create solutions to the barriers.

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What is adherence to antiretroviral treatment (ART)?

Adherence to antiretroviral treatment (ART) is taking the correct prescribed dose on the schedule specified.  In most cases, ART requires nearly perfect adherence to suppress the virus fully and prevent drug resistance.  (For information on CDC guidance and recommendations for ART adherence, refer to: http://www.cdc.gov/hiv/pwp/antiretroviraltreatment.html)

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Why do it?  What are the benefits?

  • Crucial for maintaining viral suppression and preventing drug resistance
  • Better health and long-term survival outcomes for people living with HIV who maintain viral suppression
  • Reduces the possibility of transmitting HIV to a sexual partner when virus is suppressed
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What are some of the barriers to ART adherence?

Patient-level Factors

  • Conditions that make adherence harder, like housing instability, economic considerations, and substance abuse and mental health issues
  • Poor attitudes and beliefs about treatment
  • Lack of social support

Treatment Regimen Factors

  • Complex or rigid treatment regimens
  • Side effects
  • Need for near-perfect adherence for many years

Provider-patient Relationship Factors

  • Poor relationship quality (lack of rapport, distrust, etc.)
  • Lack of shared decision-making between the provider and patient
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What are some strategies to improve adherence to ART?

Use a variety of techniques to provide adherence support and coordinated health care services for persons living with HIV.  The CDC has identified five evidence-based HIV medication adherence strategies that can be delivered by HIV providers.  (For information about these strategies, refer to: http://www.effectiveinterventions.org/en/HighImpactPrevention/Biomedical...)

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Who is involved to make it work?

Physicians, nurses, case managers, health educators, behavioral intervention counselors, and peers are all key players within the care system for persons living with HIV, and all can have a role in supporting a patient’s adherence to ART.

Martin's Story

Adherence to any drug regimen can be hard, but it is crucial for patients who are making a lifetime commitment to HIV antiretroviral treatment (ART).  We take a multi-prong approach here at the clinic where I work as an adherence counselor.  Our doctors all utilize a strategy called Partnership for Health, where they collaborate with ART patients to build successful adherence.  Since the doctors’ time is very limited, that’s where I... 

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