Adherence to Treatment

1
Adherence to Treatment
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Adherence to Treatment

• Adherence to treatment is one of the critical
  elements of ART effectiveness, clearly linked to
  patient outcomes
• Closely related to retention in care
• Assessing and supporting adherence to treatment
  requires additional competencies and resources at
  the system, site, and patient level

3
Barriers to Adherence

• Structural barriers (often to both retention
  adherence)
• Fees (overt or hidden) and lost wages
• Transportation expenses
• Facility-level barriers (stock-outs, staffing
  shortages)
• Patient-level barriers
• Forgetting to take medicines
• Fear of disclosure / stigma
• Side effects (real or anticipated)
• Travel
• Severe depression
• Current substance abuse
• Inaccurate information (including from social
  network)

4
Facilitators of Adherence

• Retention in care
• Belief that the drugs work
• Seeing positive results
• Disclosure / social support
• Simpler dosing / fewer pills
• Good relationship with health care providers
• Lack of structural barriers
• Lack of negative/inaccurate messages from
  influential community members

Mills et al (global meta analysis 2006)
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Assessing Adherence

• Patient self-report
• Pharmacy records
• Pill counts
• Retention in care?
• Treatment outcomes?
• Provider intuition?

6
Supporting Adherence

• Use of multidisciplinary teams at the site level,
  including expert patients, peer health educators,
  adherence counselors
• Provision of longitudinal care
• Relationship with health care teams
• Experience with care can enhance adherence to
  treatment
• Use of patient support tools, including
  educational materials, pill boxes, reminder
  systems
• Strong linkages to the community, including
  defaulter tracing and outreach

7
Supporting Adherence

• Moving ART delivery and support closer to the
  patient appears to enhance both retention in care
  and adherence to treatment, although data are
  scarce
• Decentralization (e.g., to PHC level)
• Home visits, home-based care

8

• Are ICAP patients adherent to treatment?
• How do we know?
• Programmatic intuition
• How can we improve adherence assessment and
  support?

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Panelists

• Larissa Polejack ICAP Mozambique
• Marie Ashie ICAP Nigeria
• Liezl Smit South-to-South partnership
• Xoliswa Keke - Swaziland