Practical Tips to Improve HIV/AIDS Medication Adherence

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Dosing is one reason why patients with HIV do not adhere to their medication regimens.
Dosing is one reason why patients with HIV do not adhere to their medication regimens.

Patients with HIV are living longer thanks to advances in antiretroviral therapy (ART). A study published in The Lancet HIV 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.1

Numerous ART medications have been introduced to further contain the virus. Notably, the 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, patient nonadherence remains a problem. 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%.2 Although the risk for nonadherence in older patients is 27% lower than in younger patients,3 the problem is nonetheless widespread, as nearly half (45%) of Americans living with HIV are aged ≥50 years.4

Researchers have explored why patients don't take their medications as prescribed and arrived at a number of conclusions. A study published in the Journal of Antimicrobial Chemotherapy found that side effects, dosing regimen, poor partner support, depressive symptoms, and alcohol consumption all play a role in nonadherence.5 Meanwhile, a study published in BMC Health Services Research identified forgetfulness as the main culprit.6 And the American Medical Association points to fear, cost, misunderstanding, lack of symptoms, and mistrust as contributing factors.7

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.8

The good news is, many of the factors leading to nonadherence 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:9-11

  • 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
  • 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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References

  1. Trickey A, May MT, Vehreschild JJ, et al. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV. 2017;4(8):349-356.
  2. Mills EJ, Nachega JB, Buchan I, et al. Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. JAMA. 2006;296(6):679-690.
  3. Ghidei L, Simone M, Salow M, et al. Aging, antiretrovirals, and adherence: a meta analysis of adherence among older HIV-infected individuals. Drugs Aging. 2013;30(10):10.1007/s40266-013-0107-7.
  4. HIV and Older Adults. US Department of Health and Human Services. Reviewed April 2, 2018. Accessed September 12, 2018.
  5. Protopopsecu C, Raffi F, Roux P, et al. Factors associated with non-adherence to long-term highly active antiretroviral therapy: a 10 year follow-up analysis with correction for the bias induced by missing data. J Antimicrob Chemother. 2009;64(3):599-606.
  6. Gadkan AS, McHorney CA. Unintentional non-adherence to chronic prescription medications: how unintentional is it really? BMC Health Serv Res. 2012;12:98.
  7. 8 reasons patients don't take their medications. American Medical Association. October 16, 2015. Accessed September 12, 2018.
  8. Schaecher KL. The importance of treatment adherence in HIV. Am J Manag Care. 2013;19(12):s231-7.
  9. Enriquez M, McKinsey DS. Strategies to improve HIV treatment adherence in developed countries: clinical management at the individual level. HIV AIDS (Auckl). 2011;3:45-51.
  10. Apgar TL. Practical ways to improve medication adherence. Fam Pract Manag. 2016;23(5):52.
  11. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. US Department of Health and Human Services. Reviewed October 17, 2017. Accessed September 12, 2018.
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