Adherence to Antiretroviral Therapy in Adults: A Guide for Trainers

Over the last five years, there has been a rapid change in treatment strategies for HIV infection. With the advent of newer antiretrovirals, treatment has moved from mono-therapy and bi-therapy to triple drug therapy or Highly Active Antiretroviral Therapy. One of the foremost concerns of ARV programs is the ability of people living with HIV/AIDS to maintain near perfect adherence over the long term. To achieve the goal of antiretroviral therapy (ART), undetectable levels of the virus in the blood, patients are required to maintain more than 90–95% adherence. Adherence is defined as a patient’s ability to follow a treatment plan, take medications at prescribed times and frequencies, and follow restrictions regarding food and other medications. This Adherence Training Manual was developed by the Horizons Program of the Population Council for the Antiretroviral Therapy Program in Mombasa, Kenya. It was designed for health workers including physicians, clinical officers, and adherence nurse counselors in ARV programs. It consists of four modules to be conducted over four sessions, which can be conducted as part of a comprehensive ART training program

Implementation of a comprehensive program including psycho-social and treatment literacy activities to improve adherence to HIV care and treatment for a pediatric population in Kenya

BACKGROUND: To achieve good clinical outcomes with HAART, patient adherence to treatment and care is a key factor. Since the literature on how to care for pediatric HIV patients is limited, we describe here adherence interventions implemented in our comprehensive care program in a resource-limited setting in Kenya. METHODS: We based our program on factors reported to influence adherence to HIV care and treatment. We describe, in detail, our program with respect to how we adapted our clinical settings, implemented psycho-social support activities for children and their caregivers and developed treatment literacy for children and teenagers living with HIV/AIDS. RESULTS: This paper focused on the details of the program, with the treatment outcomes as secondary. However, our program appeared to have been effective; for 648 children under 15 years of age who were started on HAART, the Kaplan-Meier mortality survival estimate was 95.27% (95%CI 93.16-96.74) at 12 months after the time of initiation of HAART. CONCLUSION: Our model of pediatric HIV/AIDS care, focused on a child-centered approach with inclusion of caregivers and extended family, addressed the main factors influencing treatment adherence. It appeared to produce good results and is replicable in resource-limited settings