[Recommendations from GESIDA/SEFH/PNS to improve adherence to antiviral treatment (2004)].
Since the early days of antiretroviral therapy, adherence has emerged as the milestone of success; in fact, it is the most potent predictor of effectiveness. The main factors related to adherence include the complexity of the therapeutic regimen, adverse effects, psychological problems, alcoholism and active addiction to drugs, lack of social and family support and the patient's beliefs and attitudes about the treatment. Adherence monitoring should be part of the HIV patient's regular care, and should be done with feasible, easily applied methods adapted to the different clinical settings. The minimally acceptable measures should include use of a validated questionnaire, together with data from the Pharmacy Department's drug dispensation registry. All patients that begin HAART or undergo a change of treatment should participate in a treatment education program imparted by health professionals with knowledge and experience in the management of patients with HIV infection. The health team (doctors, pharmacists and nursing professionals) should offer maximum availability to solve the doubts and problems that may occur during treatment. When sub-optimal adherence is detected, intervention strategies based on psychological therapy, educational efforts and personal advice should be attempted, in order to adapt the treatment scheme to the patient's habits and provide solutions to the problem of non-compliance. In certain situations, co-morbid conditions will also require attention. Treatment adherence, being a multidimensional problem, needs a multidisciplinary team approach. The choice of therapy, only one aspect of the multidimensional problem of adherence, must be a careful and individualized decision; however, simpler regimens with regard to the number of pills and daily dose are desirable.
Knobel
Hernando
H
Servicio Medicina Interna, Hospital del Mar, Barcelona, Spain. HKnobel@imas.imim.es
Escobar
Ismael
I
Polo
Rosa
R
Ortega
Luis
L
Martín-Conde
M Teresa
MT
Casado
José Luis
JL
Codina
Carlos
C
Fernández
Josefina
J
Galindo
M José
MJ
Ibarra
Olatz
O
Llinas
Monserrat
M
Miralles
Celia
C
Riera
Melcior
M
Fumaz
Carmina R
CR
Segador
Aurea
A
Segura
Ferran
F
Chamorro
Lourdes
L
D000465:Algorithms; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001290:Attitude; D001291:Attitude of Health Personnel; D004334:Drug Administration Schedule; D004349:Drug Packaging / Q000295:instrumentation; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000451:nursing / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D001523:Mental Disorders / Q000150:complications / Q000523:psychology; D009042:Motivation; D024802:Nurse's Role; D010342:Patient Acceptance of Health Care; D010348:Patient Care Team; D010349:Patient Compliance; D010353:Patient Education as Topic; D010819:Physician's Role; D011369:Professional-Patient Relations; D011580:Psychological Techniques; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology; D011795:Surveys and Questionnaires
D019380:Anti-HIV Agents