A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...

More documents

Recommendations

Info

A Guide to Primary Care of People with HIV/AIDS Chapter 7: Adherence to HIV Therapies 7 Viral Load
A Guide to Primary Care of People with HIV/AIDS Chapter 7: Adherence to HIV Therapies The provider should ask patients to recount exactly when and how they are taking their medications in order to identify any lack of understanding of the regimen itself or of special dietary instructions. INTERVENTIONS What can be done to improve adherence? The most important intervention is making sure patients start medication only when they are “ready.” Providers need to discuss with patients the risks associated with nonadherence that can result from starting medications before they are ready versus waiting while they “prepare.” Preparing can mean entering into substance abuse treatment, finding stable housing, or attending a support group to overcome fears of medication side effects and concerns about confidentiality. Pregnant women and patients with serious complications of HIV infection and very low CD4 counts may not have the luxury of postponing therapy, but for others, being ready to adhere may be critical to the outcome of ART. Interventions to improve adherence in chronic diseases tend to have, at best, modest effects on adherence. They are most effective if they are multifaceted, ie, they target several aspects of the adherence behavior and are repeated over time. Barriers to adherence differ among patients. Thus, interventions should be tailored to the patient’s specific needs. In addition, barriers to adherence vary over time, so interventions need to vary as well. Interventions can occur at the level of the provider, care team, clinic, and/or pharmacy. Ideally, interventions are occurring throughout the patient’s medical visit and beyond. The most commonly used interventions address patient readiness using both one-on-one education and support groups. Peer counseling and support are key for many patients to work through concerns related to medication-taking. Making patients partners in the decisionmaking process about when to start and which regimen to use is also important. The regimen should be as simple as possible and should be the one least likely to cause the side effects that the patient fears the most. Substance abuse and mental illness should be treated before starting medication whenever possible. After the patient begins the regimen, close followup and monitoring of adherence is critical, often through frequent clinic visits during the first weeks of therapy even if other medical interventions are not necessary. Providers should ask patients about adherence and address barriers to adherence at each followup visit. Providers should be open to changing the regimen if a patient has significant problems with it, whether related to side effects or to scheduling. Patients should be encouraged to use pill boxes and incorporate reminder systems as needed. Various kinds of interventions have been used in HIV and other chronic diseases (see Table 7-2). What is the role of Directly Observed Therapy (DOT) for medication adherence? Directly observed therapy (DOT) refers to medical staff supervising patients taking each dose of medication. DOT has increased treatment completion and decreased the resistance rates of tuberculosis therapy. Whether it is feasible in HIV therapy is currently under investigation. A majority of ongoing studies are using modified DOT, with only 1 daily dose of medication observed over the first several months of therapy or during the administration of methadone maintenance therapy. The results of these studies will provide valuable information about the long-term patient acceptability, cost, and efficacy of this approach to improve adherence over the long term. 7 U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau 51
Page 1 and 2:
Edited by John G. Bartlett, MD Laur
Page 3 and 4:
2004 Edition A Guide to Primary Car
Page 5 and 6:
A Guide to Primary Care of People w
Page 7 and 8:
Page 9 and 10: A Guide to Primary Care of People w
Page 59: A Guide to Primary Care of People w
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 180:
Use these quick-reference page tabs
show all

A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?