23.5.3 What other factors negatively affect adherence to ART?
There are other factors unrelated to patients or to the healthcare provider that result in poor adherence. The most common ones are the large number of tablets to be taken, high frequency of doses, and common side-effects like nausea and vomiting. Pill burden is one of the key factors that can affect adherence negatively. These factors are relatively easy to deal with — for example, patients may simply need reassurance about the treatment’s side-effects, or a change in the frequency of doses (twice versus three times per day). Other factors, especially those associated with drug interactions and food restrictions towards different drugs, may require referral to a health centre or hospital for counselling and other support services. At the health centre, health workers will help your patients to find solutions related to common adherence problems.
A patient on ART in your community tells you that he wants to stop taking his cotrimoxazole prophylaxis medication because he is also taking ARV drugs. He describes how difficult it is to take so many tablets in a day. What advice will you give him?
Reassure the patient that drugs should be taken as prescribed by the health workers. As you are not allowed to stop any of the drugs, refer him for further support to the health centre.
23.5.2 How can healthcare providers affect patient adherence?
23.6 Encouraging good adherence in patients on ART