23.6.1  What should you do before a patient starts ART?

Starting ART is a life-changing experience for most PLHIV. As adherence is a skill that your patients learn progressively, you have to start supporting them by providing information, education and counselling about maintaining complete adherence. Before starting ART, the health workers or adherence counsellors at the health centre should ensure that the topics listed in Box 23.1 are well explained to the patient. At the community level, you may also be expected to repeat this kind of information and education for patients who are about to start ART, as the patient may feel overwhelmed by the amount of information they receive.

This information will enable patients to understand their treatment regimen better, and empower them to adhere to their prescriptions more successfully once they start ART. You should also help them identify potential barriers to adherence, and organise support systems in the community or at home to promote adherence. If they encounter difficulties once they start treatment, patients should be reassured that these will be solved in partnership with the healthcare team. Patients should understand that sometimes you will refer them to other support services to help address barriers like financial difficulties, transportation, housing and food support. Discuss with your patient delaying the start of ART until significant barriers are addressed.

Tailoring treatment to the patient’s lifestyle and routine is a key factor for good adherence. For example, you could encourage the patient’s self-confidence by helping them to identify reminder strategies like daily activity planning, pill box, diary, calendar, telephone reminder, etc. Alternatively, you could suggest they associate taking ARV drugs with regular daily events such as meals or prayer, or designate specific places and times for taking medications. Patients have to plan ahead for changes in routine lifestyle, such as travel. You need to educate them about possible side effects, and instruct patients on how to manage them, or to go to the health facilities for further care and support if they are struggling to maintain 100% adherence.