title: [Recommendations from GESIDA/SEFH/PNS to improve adherence to antiviral treatment (2004)].
abstract: 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.
authors.affiliation: Servicio Medicina Interna, Hospital del Mar, Barcelona, Spain. HKnobel@imas.imim.es
authors.forename: Hernando
authors.initials: H
authors.lastname: Knobel
authors.forename: Ismael
authors.initials: I
authors.lastname: Escobar
authors.forename: Rosa
authors.initials: R
authors.lastname: Polo
authors.forename: Luis
authors.initials: L
authors.lastname: Ortega
authors.forename: M Teresa
authors.initials: MT
authors.lastname: Martín-Conde
authors.forename: José Luis
authors.initials: JL
authors.lastname: Casado
authors.forename: Carlos
authors.initials: C
authors.lastname: Codina
authors.forename: Josefina
authors.initials: J
authors.lastname: Fernández
authors.forename: M José
authors.initials: MJ
authors.lastname: Galindo
authors.forename: Olatz
authors.initials: O
authors.lastname: Ibarra
authors.forename: Monserrat
authors.initials: M
authors.lastname: Llinas
authors.forename: Celia
authors.initials: C
authors.lastname: Miralles
authors.forename: Melcior
authors.initials: M
authors.lastname: Riera
authors.forename: Carmina R
authors.initials: CR
authors.lastname: Fumaz
authors.forename: Aurea
authors.initials: A
authors.lastname: Segador
authors.forename: Ferran
authors.initials: F
authors.lastname: Segura
authors.forename: Lourdes
authors.initials: L
authors.lastname: Chamorro
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents