The Importance of Adherence
This section will review how to assess adherence, particularly in those adolescents whose HIV viral load is not suppressed by ART; examine the common adherence barriers youth experience; and explore ways providers can work with youth to improve adherence.
ART regimens require strict adherence in order to prevent the emergence of resistant HIV. Unfortunately, most HIV-infected youth find it extremely difficult to adhere to their dosing schedules consistently. Drug combinations that can be administered once or twice daily make ART easier but do not eliminate adherence issues, especially in youth. Common reasons for adolescents to miss doses include:
- Aversion to medication side effects
- Inconvenience of taking multiple pills
- Forgetfulness and distractions caused by the complications of daily life
- Negative perception of medications as a constant reminder of HIV infection
- Lack of disclosure to persons who might facilitate better adherence
Helping young patients integrate medications into their daily lives is one of the most crucial and challenging tasks for providers. Providers can improve their patients' success with adherence when they approach this issue with the understanding that adherence to HIV/AIDS treatment involves more than simply remembering to take medications. Rather, it is a complex issue involving social, cultural, economic, and personal factors.7
Providers are well aware of how good adherence facilitates viral suppression, but it is useful to find out how important patients think adherence is to their well-being. You might ask youth and their families, "How do you feel about taking breaks from your medication?" "How do you believe it might affect you if you miss one dose of your medication?" "On a scale of 1 to 10, how important do you think it is to take the medication as prescribed?" Metaphors can be very useful in describing how medications work and what happens when a dose is missed. Providers also should find out what youth and their families may have heard about the medications and assess any myths that may affect their perceptions and behavior.8 It will be important to determine whether parents and youth believe the same myths, as youth are very likely to be influenced by significant adults in their lives.
Practice makes perfect. Many youth have found that a practice trial of taking mock pills can help to identify potential adherence barriers that can be addressed before they start taking ARVs. Develop a plan with the patient that involves them eating something at various times during the day and on weekends. Suggest vitamins, a mint, a mini-candy bar, or even baby carrots at the times they would be required to take their medication. This practice run helps you and your patients learn what issues affect their readiness and adherence.
- Chesney MA. The elusive gold standard. Future perspectives for HIV adherence assessment and intervention. J Acquir Immune Defic Syndr. 2006 Dec 1;43 Suppl 1:S149-55.
- Meichenbaum D, Turk DC. Facilitating treatment adherence: A practitioner's guidebook. New York, NY: Plenum Press. 1987.