23.6 Encouraging good adherence in patients on ART
During follow-up visits, you need to keep in mind several general issues when giving advice and counselling related to adherence to HIV therapy and care to PLHIV.
First, giving information to patients, and their active involvement in deciding whether to follow ART, are essential for good adherence practices and hence for treatment success. Patients should be informed beforehand of the consequences for their lifestyle of starting HIV therapy. They should realise that the decision whether to take ARV drugs or not will influence their own long-term health. Moreover, patients should be aware of the fact that ART is a lifelong commitment. In preparing patients to start ART, other factors that may affect adherence should be discussed, including those related to disclosure of their HIV-status to partners and family members, and socio-cultural issues like stigma and discrimination.
Secondly, a patient’s adherence to ART may be affected by difficult life situations. The support and monitoring provided to patients by their healthcare providers is critical for maintaining good adherence throughout the patient’s life. In your community, you will need to undertake follow-up and monitoring activities to ensure adherence to ART and HIV care services. This is particularly important in the instances when a patient is confronted with difficult life situations. If adherence has not been strictly followed, patients need to be supported, not blamed, punished, made to feel guilty, or controlled in any way. In order to achieve this, you and the patient will need to work collectively as a team with the health practitioners in health centres and hospitals, including nurses, doctors, adherence counsellors, pharmacists, pharmacy technicians and voluntary health workers in the community.
Finally, it is important to discuss with patients and identify a person who is willing to escort PLHIV on ART to the health facilities as a treatment supporter. This may be the patient’s partner, a friend, or a family member chosen by the patient to help them remember not only to attend clinic appointments, but also to take the drugs correctly. Similarly, PLHIV or ART support groups can encourage adherence. Support groups are good sources of information and educational resources for those who start treatment, or are already on treatment.