Guidelines>Zambia HIV National Guidelines>

• 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

REFERENCED WITHIN THIS GUIDE

• Adverse Effects and Toxicity
• General Principles of Antiretroviral Therapy for Chronic HIV Infection in Adults and Adolescents
• Stopping ARV Therapy
• Treatment Failure