The Importance of Adherence

Definition of adherence:

The standard clinical definition of adherence has been taking more than 95% of medications the right way, at the right time. Over time, this definition has been broadened to include more factors related to continuous care, such as following a care plan, attending scheduled clinic appointments, picking up medicines on time and getting regular CD4 tests.

Adherence describes how faithfully a person sticks to and participates in her or his HIV prevention, care and treatment plan.

Adherence:

  • Includes active participation of the client in her or his care plan
  • Includes adherence to both medications and care
  • Depends on a shared decision-making process between the client and health care providers
  • Determines the success of HIV care and treatment programs
  • Is not static – it changes over time

Adherence to care includes:

  1. Entering into and continuing on a care and treatment plan
  2. Taking medicines to prevent and treat opportunistic infections
  3.  Participating in ongoing education and counseling
  4. Attending appointments and tests, such as regular CD4 tests, as scheduled
  5. Picking up medications when scheduled and before running out
  6. Recognizing when there is a problem or a change in health and coming to the clinic for care and support
  7. Adopting a healthy lifestyle and trying to avoid risky behaviors

Adherence to treatment includes:

  1. Taking ARVs correctly, as prescribed, for the person’s whole life, even if the person feels healthy (“every pill, every day”)
  2. Taking other medicines, such as CTX, as prescribed
  3. Not taking any treatment “breaks”
  4. Giving medications to HIV-exposed and HIV-infected babies and children as prescribed

Non-adherence includes:

  1. Missing one or many appointments at the hospital or health center, lab or pharmacy
  2.  Not following the care plan
  3. Missing a dose or doses of medicine
  4. Sharing medications with other people
  5. Stopping medicine for a day or many days, or taking a treatment break or holiday
  6. Taking medicines at the wrong times
  7. Taking medicines without following instructions about food or diet
  8. Not reducing risk-taking behavior (for example, not practicing safer sex or not delivering a baby with a trained health care provider)

References

  1. The Comprehensive Peer Educator Training Curriculum: Trainer Manual International Center for AIDS Care and Treatment Programs, Columbia University