Adherence Counselling

8/13/2019 Adherence Counselling

http://slidepdf.com/reader/full/adherence-counselling 1/26

Peer Counselor Training Course August 2005



ART Adherence



Adherence and Incomplete Viral Suppression

Paterson DL et al. Ann Intern Med. 2000:133:21

21.7

54.6

66.771.4

82.1

0

10

20

30

40

5060

70

80

90

100

<70 70-80 80-90 90-95 95

% Adherent

% P

a t i e n t s w i t h

v i r a l l o a d > 4 0

0 c o p i e



Effect of missed doses



Prevalence of 3 Day Adherence in Kampala, Uganda

Prevalence of Adherence in Kampala,Uganda

168 6

70

0

20

40

60

80

0-12 13-70 71-94 95-100

% adherence

P e r c e n t

Tusiime, et al. CROI, 2003



For optimal adherence the ideal regimen

Have one pill twice a day dosing

Have no food requirements

Have few side effects

Have no special storage requirements

Be efficacious



Barriers to adherence

Communication difficulties

Literacy levels

Inadequate knowledge or awareness of

HIV disease

Inadequate understanding of treatment

regimen




Discomfort with disclosure of HIV status

Patient attitudes and beliefs in treatment

efficacy

Depression and other psychiatric problems

Alcohol and/or active drug use




Difficult life conditions

Unstable Living conditions

Negative or judgemental attitude of health

providers



Keys to successful adherence

1. Education

2. Ongoing Support

3. Anticipate Patient factors preventing good

adherence

4. Lifestyle modification



Education

Adequate information

on HIV, ARV, how to

take medications Awareness of side

effects

Provide adherence

materials

REPETITION



Ongoing Support

Establish trust between

patient and provider

Ongoing education PEER

Counsellors

Individual counseling

Involve family and friends SUPPORT GROUPS

Family Based Care



Patient Factors preventing good

adherence Cultural beliefs about

disease and treatment

Patients knowledge of

what to expect Satisfaction with

medical care

Co-morbidities- TB,mental illness

Utilization of supportsystems



Lifestyle

Minimal number of

pills and twice a day

dosing FIT TREATMENT

INTO PERSON”S

LIFE

Few food requirement

Self monitoring tools



Questions to ask before patient

starts on ART Do you know that ART is lifelong. Your life depends on

taking the drugs every day at the right time

If you stop, you will become ill, not immediately, but after

months or years Do you know that you should not share the medication

with your relatives or friends

Did you disclose your status to somebody? This personcan help you to take your medication

Check if patients clinic attendance/previous OI treatmentadherence was good

How far are you travelling, are you able to come to theclinic on regular basis?



Clinic visit schedule

National ART program Basic counselling session I

Basic counselling session II

ARV I

ARV II (patients ready-ness assessment)

Patients starts on ARVs Monthly clinic visits



Assessment of patient ready-ness

( ARV II session) Patient should demonstrate an understanding of

his/her disease and health status

Patient should demonstrate an understanding of

his/her treatment regimen and follow up plan Patient should appear to make commitment to

adhere to treatment

Potential barriers should have been identified

and addressed to the best possible extent Patient should appear to be ready to start

HAART



Adherence monitoring

Ask questions on adherence in a respectful and non judgemental way

Many people have difficulties to take their treatment,

what are your problems? Can you tell me when and how you are taking each pill?

When is it most difficult to take your pill?

How many pills did you miss in the last days, last week,

last month? Stigma to take pills?

Do pill count



Adherence problems

Difficulties to take pills in the presence of others

Did not understand how to take the drugs

Change in routine Ran out of pills

Depressed

Alcohol/drug problems Side-effects



a.m.a.m.

p.m.p.m.

VOILÀ CE QU'UN MALADE DU SIDADOIT AVALER CHAQUE SEMAINE,

SANS GUERIR POUR AUTANT

PAST

PRESENT?



Pregnancy and post partum

Adherence more difficult

Cannot use certain ARV’s - EFAVIRENZ

Pregnancy associated morning sickness and GIupset

Concern over effects of ARV’s on fetus

Caring for newborn may compromise maternal

drug adherenceConsider: Pregnancy/postpartum centered support

groups



Children

MANY UNIQUE ISSUES

Lack of proper

pediatric formulations-crush tablets

Liquid formulations:bad taste, lots of liquid

Regular dosereadjustment basedon child’s weight



Children

Child dependant onothers for treatment

May be manycaregivers- disclosureto all??

Child unaware of own

HIV status- when todisclose

Health of caregivers



Some possible solutions:

Family based care

Same regimens as

caregivers

Constant reassessment

of home situation

Crush tablets-

EDUCATION

Family oriented support

groups

Disclosure to child



Summary

Adherence is the most important aspect that

must be followed up with ARV treatment

Information/Education

Ongoing Support

Lifestyle considerations

Personal Beliefs



Thank you

Siyabonga

Tatenda

Adherence Counselling

Documents

Transcript of Adherence Counselling