%0 Journal Article
%T When and How Should We Be Measuring Adherence To Antiretroviral Therapy in Resource-limited Settings? - When and How Should We Be Measuring Adherence To Antiretroviral Therapy in Resource-limited Settings? - Open Access Pub
%A Denise Evans
%A Matthew P Fox
%J OAP | Home | Journal of Clinical Research In HIV AIDS And Prevention | Open Access Pub
%D 2018
%X DOI10.14302/issn.2324-7339.jcrhap-13-edt.1.2 The primary goal of treatment with antiretroviral therapy (ART) is to prevent HIV-related morbidity and mortality. The effectiveness of ART has been clearly demonstrated, as have the positive relationships between adherence to ART and viral suppression, increased CD4 cell count, positive clinical outcomes,1, 2 and reduced mortality.3 More recently it has been shown to associated with reduced risk of transmission to uninfected partners4. High levels of adherence are critical for successful treatment. Accordingly, for ART programs to achieve their population level goals, individual adherence must be monitored accurately and frequentlyand prompt action must be taken when poor adherence is identified.1, 4, 6 While the issue of adherence has been extensively studied, as the ART adherence research agenda matures, several issues around ART adherence remain critically important for further investigation including: (i) how to accurately measure adherence, (ii) how often to measure adherence in order to improve treatment outcomes, (iii) what modifiable factors are predictive of poor adherence and are targets for intervention, and (iv) what interventions will be most effective at improving treatment adherence?7 Each of these questions requires careful consideration as we move into the next phase of the ART roll-out where sustaining gains already made will be just as important as expanding access. For HIV treatment, a high level of adherence equates to taking at least 80%, and possibly as high as 95%, of the correct medication, in the correct quantities, at the correct time.1, 8, 9, 10, 11 While reasonably easy to define, adherence to therapy is notoriously difficult to measure accurately7 and to date, there has been no clear consensus on the ideal way to measure it in resource-limited settings.12, 13 In order to act as quickly as possible for patients with poor adherence, clinicians working with patients taking ART could benefit greatly from a simple, inexpensive, reliable method for detecting the prevalence of poor adherence.13Such a measure would ideally be low cost, brief and non-intrusive so that it could be used many times over the course of treatment.14 It should be reliable and acceptable to respondents while also being sensitive enough to measure change. It would also be beneficial to establish the causes of non-adherence so that adherence services could be tailored to support specific patient needs.14 Several approaches to monitoring adherence, including self-report, pill counts and lab monitoring are currently
%U https://www.openaccesspub.org/jcrhap/article/43