Optimizing adherence to antiretroviral therapy.
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Date
2011-12
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Abstract
HIV has now become a manageable chronic disease. However, the treatment outcomes may get hampered
by suboptimal adherence to ART. Adherence optimization is a concrete reality in the wake of ‘universal
access’ and it is imperative to learn lessons from various studies and programmes. This review examines
current literature on ART scale up, treatment outcomes of the large scale programmes and the role of
adherence therein. Social, behavioural, biological and programme related factors arise in the context of
ART adherence optimization. While emphasis is laid on adherence, retention of patients under the care
umbrella emerges as a major challenge. An in-depth understanding of patients’ health seeking behaviour
and health care delivery system may be useful in improving adherence and retention of patients in care
continuum and programme. A theoretical framework to address the barriers and facilitators has been
articulated to identify problematic areas in order to intervene with specific strategies. Empirically tested
objective adherence measurement tools and approaches to assess adherence in clinical/ programme settings
are required. Strengthening of ART programmes would include appropriate policies for manpower and
task sharing, integrating traditional health sector, innovations in counselling and community support.
Implications for the use of theoretical model to guide research, clinical practice, community involvement
and policy as part of a human rights approach to HIV disease is suggested.
Description
Keywords
ART, ARV, follow up, HIV, non-adherence, retention, self reporting
Citation
Sahay Seema, Reddy K Srikanth, Dhayarkar Sampada. Optimizing adherence to antiretroviral therapy. Indian Journal of Medical Research. 2011 Dec; 134(6): 835-849.