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Tips on medication adherence in HIV/AIDS

Infectious Disease Advisor has tips on improving medication adherence in HIV patients.

Patients with HIV are living longer thanks to advances in antiretroviral therapy (ART). A study found that between 1996 and 2010, the life expectancy of 20-year-olds treated for HIV increased by 9 years in women and 10 years in men.

Numerous ART medications have been introduced to further contain the virus. Notably, the US Food and Drug Administration (FDA) recently approved a pair of oral treatments: doravirine/lamivudine/tenofovir disoproxil fumarate (DelstrigoTM) as a once-daily, fixed-dose complete regimen and doravirine (PifeltroTM) as combination therapy with other ART. These medications are indicated to treat HIV-1 infection in adults with no prior ART experience.

Despite advances in ART that have consolidated medication regimens, it has not solved the problem of patient adherence. That's why, this National HIV/AIDS and Aging Awareness Day – a day dedicated to spreading awareness of the challenges older Americans with HIV face – we're shining a light on a common obstacle: medication adherence.

The rate of adherence to HIV therapy in North America is a mere 55%. Although the risk for non-adherence in older patients is 27% lower than in younger patients, the problem is nonetheless widespread, as nearly half (45%) of Americans living with HIV are aged ≥50 years.

Researchers have explored why patients don't take their medications as prescribed and arrived at a number of conclusions. A study found that side effects, dosing regimen, poor partner support, depressive symptoms, and alcohol consumption all play a role in non-adherence. Meanwhile, another study identified forgetfulness as the main culprit. And the American Medical Association points to fear, cost, misunderstanding, lack of symptoms, and mistrust as contributing factors.

No matter the cause, poor adherence to ART is linked with less effective viral suppression. Not only does this put the immediate health of the patient in peril, but it also risks creating permanent treatment resistance to certain therapy regimens. In turn, this can lead to fewer treatment options and higher medication costs.

The good news is, many of the factors leading to non-adherence are modifiable. By identifying the barriers to adherence and providing strategies to combat them, you may be able to help your patients overcome these obstacles.

Here are some practical tips to consider: encourage patients to build social support networks; ask patients to rank their barriers in terms of importance, then address them starting with the easiest to overcome; simplify dosing when possible by implementing once-daily regimens with low pill counts; identify and treat underlying issues such as substance abuse and mental illness before initiating ART (refer the patient to a specialist when appropriate); avoid using medical jargon and explain in clear and simple terms what the medication will do to help the patient; keep costs in mind, as some patients will be unable to afford certain medications; suggest resources to assist with medication payments; transfer prescriptions to mail order to eliminate trips to the pharmacy; and maintain flexibility with appointment scheduling.

While there's no single strategy that will improve medication adherence in all patients, some patients may respond to these various interventions.

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