ADHERENCE TO ANTI-RETROVIRAL THERAPY
Adherence to ART includes right medications, right dosage, and at correct time as was advised by health care provider.
Adherence counselling is a key component of reducing transmission of HIV and this counselling should be done before initiation of ART and it should be a continuous process as patient needs to take medications for life.
It is important for a health care provider to establish conducive environments for the patient to agree and recognize adverse effects of not adhering to medications (ART).
CONSEQUENCES OF POOR ADHERENCE TO ARTs
- Increase in viral load-Poor adherence to ART either by skipping or stopping dosages can results into surge of high numbers of viruses because these drugs target to stop replications of these viruses.
- Decrease in CD4 counts-HIV viruses destroy white blood cells called CD4 and so adhering to ART will reduce destructions to these CD4s and making sure the immunity is maintained.
- Increase susceptibility to opportunistic infections-when the body immunity is decreased because of being destroyed by HIV viruses and CD4 counts reads <200 patient become at high risk of opportunistic infection such as TB and diarrheal diseases and the body can’t fight against these infections.
- Increase rate of HIV transmission to others-poor adherence to ART medications increase viral load and put patient at high risk of transmitting HIV to others through various ways such as unsafe sex, sharing of sharps etc.
- Increase risk of medication resistance-poor adherence to medications for example skipping or stopping ART can make the virus change its structure and hence drugs fail to work properly.
- Shorten life span-because these HIV viruses destroy body immunity and so making the body unable to fight against opportunistic infections and so suffer disease frequently and later on death.
FACTORS CONTRIBUTING TO POOR ADHERENCE TO ARTs
- Tired of using medications because they are lifelong medications and patient is required to take every day and for the whole of his/her life and so making the patient tired and stop using.
- Fear of being seen as HIV patient-and fear of being stigmatized when patient attends clinic or during drugs refill.
- Lack of CTC services in some of areas-ARTS are normally provided from special recognized health facilities and not otherwise and so making some patients not able to access in these centers because of distance.
- Lack of family support-or someone to encourage patient to use medications, it is obviously oral medications are tiresome and so there is a need to have a supporter to motivate and remind the patient of medications when he/she forgets.
- Lack of education/knowledge about adverse effects of not adhering to ARTS
- Lack of tolerability on side effects of ARTS for example nausea, diarrhea, lack of sleep etc.
- Depression and other mental illnesses-these are some of diseases which affects patients ability to make right decisions and so failure to become adherent to correct dosages hence need assistance
FACTORS TO PROMOTE GOOD ADHERENCE TO ARTS
- Provision of education to the society on adverse effects of not adhering to ARTs through mass medias, posters, magazines etc.
- To create conducive environments on availability and accessibility of ARTs medications, with the possibility of making them available in community pharmacies, and in areas where CTC is far or not available.
- Involvement of family members or any supporter who is ready to motivate and encourage the patient to adhere to medications.
- Accepting disease condition and readiness to use medications for life.
- Building trust relationships between patient and health care providers.
- To have a fixed combination of different drugs in one pill so as to reduce pills burden.