Summary: Adherence

• Adherence to HIV therapy means sticking to the timetable for taking your pills and taking all the doses exactly as prescribed. Adherence is also described as compliance.

• Adherence to HIV medication is important because many of the drugs used to fight HIV disappear from the blood very quickly. This can allow HIV to develop resistance to your treatment if you miss doses or take them incorrectly. Resistance will cause your treatment to fail, and will reduce the benefit you will gain from other HIV treatments in future.

• The level of adherence required for effective HIV therapy is high - levels below 95% are consistently associated with a poorer viral load or CD4 response, and with faster disease progression.

• There are many practical strategies which you can employ, with the support of others, to help you take your medication successfully. The key to many of these is planning ahead to avoid problems before they occur, and knowing where to go for help if you do have a problem.

• A range of tools have been validated as measures of adherence to HAART (self-reported behaviour, electronic monitoring, pill counts, drug level monitoring). Some of these are more suited to routine use within clinical settings than others, however. Many doctors favour self-report as a practical, affordable, and patient-centred option.

• Attempts to identify predictors of low adherence often produce conflicting results. Rather, the subject is best approached by recognising that all patients are capable of both high and low adherence, and all require support tailored to their own circumstances.

• Adherence can be effectively supported by structures, ongoing, multi-faceted interventions which have input by the full multi-disciplinary health care team