[pronut-hiv] Importance of adherence in ART

["Nkuoh Godlove" <nnkuoh@yahoo.com>]

THE IMPORTANCE OF ADHERENCE COUNSELING IN INITIATING ANTIRETROVIRAL THERAPY

Adherence is the engaged & accurate participation of an informed patient/client in a plan of care. It is a broader term than compliance.  It includes entering into & continuing in a program of care plan; meeting appointments and tests as scheduled, taking medications as prescribed, modifying lifestyle as needed and avoiding risky behaviors.

A baseline adherence assessment should be conducted for all patients entering an HIV/AIDS care and treatment program. Adherence support is a component of ARV use and expert guidelines emphasize that ARVS should not be prescribed in absence of it.

SOME IMPORTANT STEPS TO FOLLOW DURING ADHERENCE COUNSELING

First meeting with the Adherence counselor:

 What he/she understands by being HIV positive and having AIDS.

Does she/he know he/she is HIV positive?

Who told her/him? Where & when?

Did she/he understands all what was discussed during posttest counseling?

 If not satisfactory with these responses, pretest counseling and testing should be done. 

Assess patients knowledge on HIV/AIDS and correct as necessary.

Explore patients psychosocial milieu to determine if additional challenges exist e.g. depression, fear of stigma, lack of family support etc. Also assess the nutrition aspects, which may help in determining the particular regimen.

Verify if there are any relatives to whom the patient have disclosed and if not encourage to do so as they can be supportive.

Assess patients distance from health unit and see if it can be a barrier to adherence.

Is the patient getting support from some individuals or support group which can help him/her continue in the plan of care & treatment.

Assess the patients knowledge on ART.

Discuss the fact that ART is not a cure, it is to be taken for live and does not prevent transmission of the virus. Help patient understand that there is a criterion for initiating ART including some baseline laboratory tests. Mention costs of ART and baseline tests. It is not like anyone who is HIV infected should automatically be put to therapy.

Prior to initiating therapy patients should know which side effects to expect, what they can do to manage them and which side effects would necessitate an early return. Let them know the serious consequences of non  adherence to medication.

Mention cost of laboratory work and medications. Stress the need to adjust lifestyle in areas of consumption of other drugs, sexual activity and smoking

 For patients who come for follow refills; ask in a non-judgmental way how well he is adhering to therapy e.g. every one misses doses time by time. In the last two weeks, how many doses have you missed? As the patient improves clinically, remind him/her that this improvement is directly tied to his adherence with the ART therapy. Always ask to see and review remaining drugs. 

 FACTORS THAT CAN INFLUENCE ADHERENCE.

Disclosure to spouse and other supportive relatives.

Acceptance and positive living.

Nearness to treatment and care centers.

When a patient understands his/her problem better, adherence can be improved.

Availability of good treatment and care centers, good laboratory and drugs.

Provision of assistance to patients who cannot afford to take care of themselves.

 
 Contact: 

Nkuoh Godlove

Cameroon Baptist Convention Health Baord

PMB 42 via Bamenda, North West province

Republic of Cameroon.

2377565537