23.1 What is adherence?
Adherence to treatment in the context of any disease is essential to maintain and improve a patient’s health. Similarly, adherence to HIV therapy is essential for the general improvement of quality of life of PLHIV. In the context of HIV treatment, adherence means that a patient takes antiretroviral (ARV) drugs correctly. Incorrect drug taking may not only be inefficient in treating HIV infection, but it may also lead to drug resistance (Study Session 22, Section 22.3.2). Using these drugs correctly involves taking the right drug, in the right dose, in the right frequency, at the right time. We will describe the importance of each of these aspects of taking drugs in turn.
- The right drug: The drug that is prescribed by the health practitioners should not be changed or replaced by any other drug. PLHIV may take various drugs at any given moment depending on their health situation. Usually, patients take ARV drugs to treat HIV infection and other drugs, such as cotrimoxazole, to prevent opportunistic infections. Therefore, it is not unusual for PLHIV to become confused, and they may find it difficult to differentiate between the many different drugs they may be taking (Figure 23.1). Your support is essential in enabling PLHIV to take the right drugs.
- In the right dose: As you learnt in the previous study session, ARV drugs have specific dosages for adults and children. The dose may also sometimes be different amongst adult patients depending on their health status. Therefore, if you are making follow-ups for patients who are taking drugs for HIV in your community, you have to make sure and encourage them to take the correct dose of the drugs.
- With the right frequency (number of times per day): Like other drugs, ARV drugs are prescribed by health practitioners at the health centre or hospital with instructions on how frequently they should be taken in a day. You have to advise patients to follow those instructions strictly.
- At the right time: The time at which ARV drugs should be taken is also essential, maintaining a regular and correct time difference between doses.
Taking the correct ARV drugs at the right doses and frequency, spaced at regular intervals, helps patients to maintain the optimum levels of drugs in their blood to prevent HIV multiplication.
Based on what you learnt in previous study sessions, why is it important to take ARV drugs for the duration of a patient’s lifetime?
ART is a lifelong treatment because it doesn’t eradicate HIV infection; rather it suppresses the multiplication of the virus in the body. This prevents the destruction of CD4 lymphocytes and maintains the normal function of the immune system.
Viral replication refers to the production of new viruses by infected cells. ‘Viral replication’ and ‘viral multiplication’ can be used interchangeably.
Note that adherence to HIV treatment and care not only involves the points above concerning ARV drugs, but also attendance by the patient to all scheduled visits at health centres or hospitals to undertake regular check-ups and clinical assessments. Regular clinical follow-ups may include clinic appointments, laboratory tests and prescription refills. You need to support and encourage PLHIV to regularly visit health facilities as advised by the health workers who follow their treatment and/or provide care. In fact, adherence should involve a long-lasting partnership between the patient and the whole healthcare team, including Health Extension Practitioners (Section 23.5.2).