- Good adherence means:
- -Drugs should be taken at approximately the same time of the day to maintain constant drug blood levels.
- -Taking all medications at the right time, in correct doses, with or without food (if indicated).
- -Not skipping doses or starting and stopping therapy.
- NNRTIs have low genetic barrier to resistance; adherence essential to prevent development of resistance and ultimately treatment failure.
- Give written dosing instructions to patients.
- Provide one-on-one counseling to each patient:
- -Several counseling sessions may be required before patient truly "ready" to start ART
- -Counseling should include information about side effects: how to recognize serious adverse effects, when to seek care and how to prevent or manage mild side effects
- Encourage patients to identify treatment supporters (family members, buddies) and include them in counseling
- Find ways to help patients overcome obstacles, such as disclosure
- Link patients with adherence support groups
- Counsel patients to avoid drug abuse and to refrain from excessive alcohol use
- All patients should be given information about how and when to contact their health care provider
- Assess how patient is taking drugs at each visit
- Use open ended and targeted questions and other tools (e.g. pill counts) in adherence assessment.
- Assess adherence at every contact with adherence support worker or home-based care giver
- Refer patients with suspected or identified non-adherence to ART care time immediately
- Patients unlikely to volunteer information about non-adherence
- Assessing adherence is not done with 1 simple question:
- -Ask how patient is taking prescribed medications
- -Probe, verify, ask follow-up questions
- -Assess barriers to adherence and help patient to find ways to overcome them
- -Pill counts can be helpful