Version June 2024
| Initial intervention strategies |
| Establish trust and identify mutually acceptable goals for care. |
| Obtain explicit agreement on need for treatment and adherence. |
| Identify depression, low self-esteem, or drug use that may decrease adherence. |
| Treat prior to starting therapy, if possible. |
| Identify family, friends, health team members, or others who can help with adherence support. |
| Educate patient and family about the critical role of adherence in therapy outcome. |
| Identify the adherence target: 95 percent of prescribed doses. |
| Educate patient and family about the relationship between partial adherence and resistance. |
| Educate patient and family about resistance and constraint of later choices of antiretroviral drug; ie, explain that while a failure of adherence may be temporary, the effects on treatment choice may be permanent. |
| Develop a treatment plan that the patient and family understand and to which they feel committed. |
| Establish readiness to take medication by practice sessions or other means. |
| Consider a brief period of hospitalization at start of therapy in selected circumstances, for patient education and to assess tolerability of medications chosen. |
| Medication strategies |
| Choose the simplest regimen possible, reducing dosing frequency and number of pills. |
| Choose a regimen with dosing requirements that best conform to the daily and weekly routines and variations in patient and family activities. |
| Choose the best-tasting liquid medicine possible. |
| Choose drugs with the fewest side effects; inform patient regarding medication side effects; anticipate and treat side effects. |
| Simplify food requirements for medication administration. |
| Prescribe drugs carefully to avoid adverse drug-drug interactions. |
| Follow-up intervention strategies |
| Monitor adherence at each visit, and in between visits by telephone or letter as needed. |
| Provide ongoing support, encouragement, and understanding of the difficulties of the demands of trying to be >95 percent adherent with medication doses. |
| Use patient education aids including pictures, calendars, stickers. |
| Use pill boxes, reminders, alarms, pagers, timers. |
| Provide nurse, social worker, or other practitioner adherence clinic visits or telephone calls. |
| Provide access to support groups or one-on-one counseling for patients with depression or drug use issues that are known to decrease adherence. |
| Provide pharmacist-based adherence clinics. |
| Consider gastrostomy tube use in selected circumstances. |
| Consider a brief period of hospitalization during therapy in selected circumstances of apparent virologic failure to assess adherence and reinforce that medication adherence is fundamental to successful antiretroviral therapy. |
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