Adherence is often treated as the goal of medical intervention when in fact it is a means to an end. For health care providers, the ‘end’ is the suppression of the virus and the prevention of viral resistance and the maintenance of the health of the patient. These goals may or may not coincide with those of the patient. The issue that must be addressed is why adherence to HAART is crucial to their being able to achieve their goals. Unless the patient can find a reason for adherence that is meaningful to him or herself, the incentive to adhere to rigorous dosing schedule may be lacking.
-Jani, A. A., ed. 2002. Adherence to HIV Treatment Regimens: Recommendations for Best Practices. Washington, DC: American Public Health Association (APHA).
As treatment of HIV infection with antiretroviral medications becomes a reality in developing countries, adherence to the treatment regimen also becomes a bigger issue that needs to be addressed in these settings. Perfect adherence of at least 95 percent is needed for patients on ART to keep the viral load at undetectable levels for as long as possible and to maintain the functionality of the immune system. Several patient and regimen-related issues still need to be overcome to achieve optimal adherence. In many cases additional interventions are required for both the health care provider and the patient in order to address issues of non-adherence.
From a literature review on global adherence of ART practices to the development of an Adherence Promotion Planning (APP) Tool, RPM Plus has undertaken a number of activities to analyze and document adherence practices in resource-constrained settings while also identifying interventions that can be used to improve levels of adherence among patients. In 2006 RPM Plus collaborated with the
International Network for Rational Use of Drugs (INRUD) to develop and administer a survey intended to capture ART adherence practices in resource-constrained settings represented by five East African countries—Ethiopia, Kenya, Rwanda, Tanzania, and Uganda. Findings revealed that several interventions are being used to improve adherence in resource-constrained settings, many of which are utilized in high-income settings.
Two years prior in 2004, a survey intended to determine if incentives and enablers are being used to improve outcomes of antiretroviral treatment illustrated that while there is little or no documentation of adherence to ART practices in resource constrained settings, adherence issues are being taken seriously by health care service providers.
Currently, RPM Plus is developing the APP Tool, which aims to assist health facilities in identifying context specific interventions for improving adherence. The Tool provides steps to address the barriers to achieving optimum levels of adherence while taking into account locally available resources. The planning approach was adapted from a tool previously developed for national TB programs in collaboration with
WHO/StopTB.
If you have questions or would like more information on this initiative please contact us at surveyrpmplushiv@msh.org.
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