23.2  What is non-adherence?

Non-adherence is the patient’s inability to take their drugs correctly, or attend scheduled clinical visits in the prescribed manner as recommended by their healthcare providers. Non-adherence has a number of implications for the health outcome of your patients. A patient who is not taking drugs correctly will have poor health and get ill with opportunistic infections frequently. They may also end up developing resistant strains of HIV (or other infectious agents in the case of non-adherence to treatment for opportunistic infections) that will be difficult to treat with the conventional treatments available in your settings. Therefore you need to help and actively advise patients to strictly adhere to all of the services they receive from the health facilities.

In addition to good adherence, other factors should be considered if a patient with HIV needs to be started on ART.

The health practitioners who are monitoring the patient at the health centre or hospital should check whether they are eligible to start ART. This is carried out by clinical assessment (i.e. symptoms and/or signs of disease), and by checking the CD4 cell count of the patient.