Antiretroviral Adherence Interventions: Translating Research Findings to the Real World Clinic

Abstract

The success of potent combination antiretroviral therapy (ART) for HIV infection is compromised primarily by failure to maintain optimal levels of adherence over the long term. Recent reviews suggest behavioral interventions to promote ART adherence can have significant effects, but these tend to be small and to diminish over time; sustained improvements in biomarkers are particularly elusive. In this article, we update current reviews, focusing specifically on the 13 studies evaluating behavioral interventions to promote ART adherence published since September 2007. We describe the range of intervention strategies employed and qualitatively summarize findings of their efficacy. In conclusion, we consider implications and offer strategies for enhancing adherence in clinic-based HIV care prior to ART initiation, at initiation, and over the course of treatment.

Role of the Pharmacist in Caring for Patients with HIV/AIDS: Clinical Practice Guidelines

“…The pharmacist's inquiries about adherence should be phrased in a nonjudgmental, routine manner, through open-ended questions that acknowledge the difficulty of perfect adherence. 122 The pharmacist should ascertain not only whether doses are being missed but also the patient's knowledge of medication names and prescribed dosing regimen, including attention to dietary requirements, and whether there may be a pattern to any nonadherence, for example, on weekends or when daily routines change. 123 This aspect of care will become even more crucial as the HIV-infected population ages and the pill burden increases with polypharmacy for treating comorbidities of aging.…”

Adherence to Antiretroviral Therapy in Managed Care Members in the United States: A Retrospective Claims Analysis

“…Comprehensive, multidisciplinary approaches are required to address varied health care settings and patient populations. [19][20] Decreasing pill burden by simplifying the ART regimen is one method used to promote ART adherence. 1,21 STRs that reduce pill burden to as little as 1 pill taken once daily have been associated with improved adherence, reduced hospitalizations, and improved viral suppression.…”

Rapid Screening of HIV Reverse Transcriptase and Integrase Inhibitors

“…To avoid the development of drug resistance, drug concentrations must be maintained at levels that fully suppress HIV replication. Poor adherence to the therapeutic regimen exacerbates the problem, and can lead to the rapid development of resistance [7][8][9] . Although drug concentrations can vary in patients due to differing absorption, metabolism, distribution, and excretion levels, high drug concentrations can lead to toxicity 10 .…”