Routine adherence support

Clinical description

• The following patient groups are at high risk for poor adherence (and interruption of treatment)

and need special attention: children, adolescents, previous LTFU, depression, new ART initiation (particularly in pregnancy or breastfeeding women), excessive alcohol use, living far from clinic, seasonal workers.

• Ask at every clinical assessment visit:

o What challenges have you had taking your ARVs? o What days / time of day are you most likely to forget taking your meds? (Weekends, weekdays, mornings, evenings?)

• Remind patients of the importance of perfect adherence at every clinic visit:

o Initial ART counselling o Follow-up group counselling o Start intensive adherence counselling (IAC) if any sign for poor adherence (see page 86)

• Give practical strategies how to achieve optimal adherence:

o Build ARVs into the daily routine (e.g., before washing the face, after evening meal)

o Ask family or friends to remind o Set a daily alarm on the cell phone o Keep a ‘drug diary’ and mark every tablet taken

• Encourage honest dialogue. Avoid giving the impression of ‘policing’ the patient. Work with

patients to help them achieve good adherence.

• Poor adherence always has valid reasons, and most can be resolved: vomiting, transport problems,

domestic problems, (perceived) side effects, psychological problems, wrong understanding, etc.