HIV Adherence in the Community

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HIV Adherence in the Community

Antiretroviral therapy (ART) is a lifesaving drug that suppresses HIV replication to prevent infections, restore immune function and extend lifespan. Adherence to treatment with ART is essential for its effectiveness; if taken improperly, the medication could stop working or people may develop resistance. Furthermore, social support networks and peer pressure play an integral role in maintaining long-term adherence to treatment.

Community-based ART provides services close to home, reducing costs and time-to-treatment compared to clinic-based care. This approach has several advantages such as convenient delivery times, lower transportation expenses and improved access for those living in rural areas.

Adherence to ART is enhanced when barriers are removed between follow-up appointments and continuity of care, helping avoid lapses in compliance when participants run out of pills. Furthermore, it reduces missed visits by giving participants access to staff if they need refills or rescheduling meetings.

This approach is ideal for remote settings where people live in small communities or villages, but it necessitates training for staff involved with carrying out the intervention. Furthermore, clinic-based care is more efficient than individual visits at various times with a health worker standing in line for each procedure.

The DO ART Study randomly assigned 1531 participants to receive immediate or deferred ART in their community for up to 3 months. They received ART initiation, monitoring and refills from mobile vans (the “hybrid”) as well as traditional clinic-based treatment options. To assess the efficacy of each delivery strategy, HIV viral load and CD4+ counts were tracked at baseline, 6 weeks after starting treatment, and one year post-enrollment.

People living with HIV (PLWHs) may face challenges adhering to their antiretroviral therapy (ART). Sickness or depression can make it harder for PLWHs to stay on track with their regimen; substance use (drugs and alcohol) may also interfere with motivation to stay on track.

Some PLWH may temporarily discontinue taking ART for short bursts of time or even restart it after taking a break, commonly referred to as a “drug holiday.” Unfortunately, discontinuation can become an obstacle to HIV care; those who discontinue are three times more likely to die from AIDS than those who remain on medication. To reduce this risk factor for discontinuing ART and guarantee patients don’t face an automatic assumption that they will continue taking their HIV medications, identification of risk factors for stopping treatment should be done prior to any decision being made regarding discontinuation.

This can be achieved through various methods such as asking patients their reasons for stopping or starting ART, and checking in regularly to see if they feel well and remain on their current regimen. This approach has proven successful in other high-risk contexts like Kenya or South Africa.

This study reveals that ART non-persistence is common among PLWH in high-risk contexts and an important obstacle to HIV care. Therefore, clinical settings and HIV research should focus on methods to predict ART discontinuation and re-engage those who have stopped taking treatment. This could inform clinical practice, social/behavioral interventions, policy decisions, as well as future research initiatives.

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