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Adherence to Treatment

(Finalized March 2005)

What is adherence?

Adherence to treatment means taking your medications exactly the way they are prescribed by your doctor. This means taking the right amounts of the medications (dosages) at the right time in the right way (for example, on an empty stomach or with food). It also means taking your medications properly on a consistent basis over time and not missing doses of your medications.

Why is adherence important for HIV treatment?

For anti-HIV medications to work, enough amounts of the right kinds of medications must be present in your body all the time to prevent HIV from reproducing. Since the medications only stay in your body for a certain length of time, missing doses of the medications may affect the amounts of medications present in your body. If the amounts of the medications in your body drop too low, the medicine may not be able to control the virus.
When that happens, HIV can reproduce more actively and can change forms (mutate) so that it becomes resistant to the anti-HIV medications. Then the medications would no longer be effective.
Studies have found that the effectiveness of HIV treatment decreases significantly if you miss your doses more than 5% of the time.

Why is adherence difficult?

Taking any medication(s) regularly is often difficult for people. Taking HIV treatments can be more difficult for many reasons:

1. HIV treatment regimens can be very complicated and may involve taking many drugs several times a day.
2. Some medications need to be taken on an empty stomach, while others must be taken with meals.
3. Food or other drugs may have to be avoided being taken at the same time as anti-HIV medications, which can be very difficult.
4. The medications may have unpleasant side effects.

Other factors that make it hard for people to adhere to HIV treatment regimens may include:

1. simple forgetfulness
2. sleeping through doses
3. traveling away from home
4. feeling sick or depressed
5. difficulty with access to medication supply
6. hectic or unpredictable work schedule
7. confidentiality concerns (other household members or co-workers not knowing your HIV status)
8. unstable housing or economic situations
9. substance uses such as alcohol or recreational drugs
10. other co-existing health problems such as diabetes or hepatitis
11. lack of supportive relationships
12. wish to not be constantly reminded of having an illness

What can I do if I have problems adhering to my treatment regimen?

If you keep missing doses, it may be a sign that the treatment plan is not suitable for your lifestyle or that it is causing some other problems such as side effects.
It is important to tell your doctor or pharmacist as soon as possible when you realize you have a problem adhering to your treatment regimen. They may be able to work with you to find ways to address these problems or you may have to switch to a different treatment regimen.

Tips to improve adherence:

Plan ahead before starting an HIV treatment regimen:

1. Get the information you need about making decisions about your treatment regimen.
2. Tell your doctor or pharmacist about any factors that may affect your ability to adhere to the treatment regimen (such as schedule, number of pills, possible side effects, living or work situations).
3. Develop a schedule of the medications and try practicing with vitamin pills or jelly beans to find out what might affect your ability to take them consistently.
4. Learn from this and work with your doctor and/or pharmacist to develop a regimen that is right for you.

Practical tips to help maintaining adherence:

1. Take your medication at the same time(s) each day.
2. Use a timer, alarm watch, pager or other reminder device.
3. Use a pill box to take extra doses of medications with you when you are out.
4. Get your pharmacy to put your medications in a dosette or blister pack for you each week.
5. Keep a medication diary and check off your medications each time you take them.
6. Keep backup supplies of your medications at places where you regularly stay (such as your workplace or your partner’s place). Make sure you follow the storage instructions of the medications, as some may lose their effectiveness if not kept refrigerated.
7. Plan ahead for weekends, holidays or travel.
8. Make sure you don’t run out of your medications.
9. Talk to other people with HIV/AIDS and learn from their experiences.
10. Develop a supportive network of friends and family who can help remind you to take your medications.