Intensive adherence counselling

Clinical description

Indications

• Questionable or confirmed poor adherence noted at regular visit / late for appointment
• Low level viraemia, or VL result 1000+ copies/ml (see page 92).

Step-by-step guide

• Intensive adherence support for patients with unsuppressed viral load must be provided by an

experienced clinician or nurse, not by a lay provider

• Ask both patient and the treatment supporter to attend.
• Explain the information presented in the boxes with Key facts:

o Starting ART (page 76)

o Achieving optimal adherence (page 85)

o Monitoring for treatment failure / HIV drug resistance (page 90)

• Routinely screen and manage depression and substance use disorder using PHQ-2 and DSM-5 (see

section 12.4 on page 56)

• Make a (verbal) contract with the patient and the treatment supporter:

o “We will check your VL again in 3 months.” o “We will work together to help you remember to take your tablets as prescribed. This will help us find out if your current ARVs are still able to make your VL undetectable.”

• Look for specific problems / situations that get in the way of good adherence. Ask for:

o Frequent travel / boarding school o Conflicts at home / lack of privacy / stigma

• Agree on an action plan and write instructions in health passport: select the most suitable practical

strategies from page 85. Review specific strategies for children / adolescents (page 88)

• Consider giving monthly appointments until follow-up VL is due (after 3 months of good

adherence).

o Do pill count and assess adherence closely at each follow-up visit o Review action plan: what has worked – what has not? Revise plan if necessary.

Continuing ART