Adherence Considerations

Retention in Care and Adherence Are Not Static States for Your Patients1

Life’s unpredictability can challenge your patients’ adherence to the continuum of care1

Building a trusting environment for the people you treat can help you learn about specific adherence challenges they may face, which can include:

Personal, Behavioral,
Medical & Structural
Barriers1

eg, stigma, substance
abuse, lack of transportation

Clinical Barriers1
eg, appointment
scheduling difficulties,
limited clinical hours

System Barriers1
eg, co-pays, prior
approvals

When making HIV treatment decisions, DHHS guidelines recommend considering key factors that affect adherence, including1:

  • A person's daily schedule
  • Tolerance of pill number, size, and frequency
  • Any issues affecting absorption (eg, use of acid-reducing therapy, food requirements)

According
to the DHHS Guidelines

  • People with HIV who have ART adherence challenges should be placed on regimens with high genetic barriers to resistance.* Side effects, out-of-pocket costs, convenience, and individual preferences should also be considered.1
  • *Please see DHHS guidelines for specific recommended antiretrovirals.

Continue to counsel your patients to take treatment as prescribed.2

Since people in your care may shift back and forth on the care continuum, it's important to recognize that adherence should be a collaborative effort between you and your patients.1

Some strategies to help set people with HIV up for improved adherence, can include1:

Strategy for Improving Adherence
Some Examples
Evaluate your patients’ knowledge about HIV infection, prevention, and treatment and provide HIV-related information based on this assessment
Provide your patients with information about HIV, including the therapeutic and prevention consequences of poor adherence and the importance of staying in HIV care.
Involve the patient in ARV regimen selection
Work with your patients to incorporate treatment into their routine daily activities. Review potential side effects, dosing frequency, pill burden, storage requirements, food requirements, and discuss the potential consequences of poor adherence with your patients.
Strengthen early linkage to care and retention in care with patients and provide needed resources
Assist in making regular appointments with patients and provide or refer for resources to address and overcome barriers to care.
Provide a multidisciplinary healthcare team that is accessible, trustworthy, and nonjudgmental
Include a team of healthcare providers, nurses, social workers, case managers, pharmacists, medication managers, and administrative staff who are all trained on providing compassionate and patient-centered care.
Assess adherence at every clinic visit and use positive reinforcement to foster adherence success
Monitor viral load as a strong biologic measure of treatment adherence and offer patient a simple self-assessment rating scale for adherence. Inform patients of the benefits of being undetectable and increasing CD4 cell counts.

According
to the DHHS Guidelines

  • People with HIV who have difficulties with adherence to appointments or ART should be provided additional adherence support using a constructive, collaborative, nonjudgmental, and problem-solving approach.1

Continue to counsel your patients to take their medication as prescribed.2

Please see full Prescribing Information for BIKTARVY® and DESCOVY®, including BOXED WARNINGS.

ART, antiretroviral therapy; DHHS, US Department of Health and Human Services.

References: 1. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Department of Health and Human Services. Updated September 12, 2024. Accessed September 24, 2024. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf 2. BIKTARVY. Prescribing information. Gilead Sciences, Inc.; 2024.