A critical factor impeding effective HIV treatment in Nigeria is adherence. Several people are switching to the second line drugs because their erstwhile combination is proving ineffective because the virus has since developed resistance. Drug adherence is important to effective treatment. In actual fact, patients are advised not to miss their drugs more than once in a month to achieve success. The chart below (courtesy MSF) indicates that in patients whose viral load has become undetectable, they have over 95% adherence level.
Several reasons and factors have been adduced to explain why people do not adhere to their drugs. Reasons ranged from the several side effects of the Anti retroviral drugs, but when put side by side with the benefits inherent in treatments it does not justify why someone will not want to adhere to treatment. In the chart below, it will be seen that less than 30% of patients mentioned the several side effects as reason, then if it is not the side effects why then do patients not adhere to their treatment regimen? In over 70% of patients, it was found that poverty is the main reason why they are not adhering.
72% of patients under the MSF project for instance have had treatment interruption at one time or the other. Over 50% live with less than $1 per day. It was further revealed that 39% borrow money from friends and relatives to access treatment at a time while over 18% actually sold their properties. 2.5% of patients are presently on the second line drugs, which could be serious burden to them because some of the second line drugs have to be kept at certain temperature. The fact is that most patients do not have a means to do this as several people are too poor to own refrigerator, and for those few that has, it is another burden to power them with the power situation in Nigeria. As it is, will it be out of place to call for more credible intervention that will ensure adherence and get more people on treatment.
Aside of poverty, some people just find it difficult to adhere for several other reasons. In this piece by Mark Cichocki-www.aids.about.com, you will have access to adherence strategy that can work for you.
Reasons for Poor Adherence
With any type of medication regimen, whether it is to treat HIV, diabetes, or high blood pressure, there are several reasons why people have difficulty adhering to their prescribed medications.
Several studies have been done to identify these reasons. One study found:
- 40% of people said they simply forgot to take their meds
- 37% slept through a dose
- 34% were away from home
- 27% had made a change in their therapy routine
- 22% were too busy to take their meds
- 13% were too sick
- 10% were experiencing side effects
- 9% were suffering from depression
So what can be done to improve adherence? The first step in better adherence begins before the first pill is taken and continues throughout the course of treatment.
Strategies for Better Adherence
These simple points will assist you in adhering to even the most difficult regimen.
- Integrate the regimen into your daily life
Fit the meds into your life instead of structuring your life around your meds.
- Count out your doses in advance
Use a pill box to prepare your meds a week in advance.
- Keep a checklist
Check off a dose when it is taken to avoid missed or double doses.
- Use a beeping alarm
Use a beeping watch or timer to remind you when a dose is due.
- Put dosage times into your daily planner
Just like an appointment, add a dose into your daily planner to remind you when a dose is due.
- Call in refills a week before you run out of pills
This will allow for any delays in getting your meds at the pharmacy.
- Establish and use a support network
Find friends or family that can assist you in taking your meds. Local "buddy lines" can help with reminders and serve as a partner in therapy. Realizing others are struggling as you are can help with feelings of isolation. Develop a working relationship with your healthcare team.
- Plan ahead for traveling or weekends
Pack your meds and keep them with you when traveling. Keep in mind that your schedule may change while on vacation and you will need to adjust how you take your meds.
- Arrange for privacy
If you have to hide the fact you take meds, arrange for some private time at work when you can take your meds. Scout out a private place such as a bathroom where you can take your meds.
- Keep a diary
Write down successes as well as failures to remind you what has worked and what has not. Record missed doses to identify times or doses that need to be worked on to improve adherence.
Choosing a Therapy
The key in choosing the right therapy is to choose a therapy that he or she can incorporate into their life. Different people have different schedules, different social and living arrangements, and different abilities to understand and adhere to regimens. For instance, a homeless person my not be successful in taking combinations that require medication refrigeration. Or a person who works all day and can't be open about taking meds, may not do well with drugs that require an afternoon dose to be taken while at work. Finally, a person who works night shifts may not do well with regimens that require doses at lunch time.
Access to Drugs
An important key to adherence is assuring that drugs can be accessed consistently. Does the person have a way to pay for his drugs, to pick them up at the pharmacy, to store them properly, and to get refills when needed. Adherence is impossible without being able to have a stable supply of medicines at all times.
Support
Taking meds is a difficult proposition and can't be done without the support of your health care team. People must have access to the health care team when problems or questions arise. They need to have telephone numbers to call if they have problems with side effects, fears or concerns about symptoms, or need new refills. Working with your health care team is a must if adherence is to be successful.
Commitment
Possibly the most important key to success is a commitment to therapy. A person must be willing and want to adhere. Commitment is a must especially when side effects and emotional issues arise while taking meds. Without the hard work and commitment to treatment, a person's therapy will be unsuccessful.
Adhering to a medical regimen is never easy. But with the right information, and the commitment to hard work, HIV therapy can be adhered to and will be successful.
The advent of HAART therapy has given people infected with HIV a new lease on life. But along with these benefits there are some problems. The biggest obstacle to successful treatment is adherence to your regimen. Here are 10 tips that will help.
- Integrate the regimen into your daily life
Fit the meds into your life instead of structuring your life around your meds.
- Count out your doses in advance
Use a pill box to prepare your meds a week or even two weeks in advance. Note, some medications need refrigerated. If that is the case, keep the pill boxes in the refrigerator or a cool place.
- Keep a checklist
Make a daily checklist of the pills you have to take and the times you should take them. Check off each dose after it is taken. This will help to avoid missed or double doses.
- Use a beeping alarm
Use a beeping watch or timer to remind you when a dose is due. many HIV practices can supply such alarms or can help you find one that is affordable and sometimes free of charge.
- Put dosage times into your daily planner
Just like an appointment, add your medication doses into your daily planner to remind you when a dose is due.
- Plan ahead for traveling, refills and weekends
Pack your meds and keep them with you when traveling. Keep in mind that your schedule may change while on vacation and you will need to adjust how you take your meds. Also, plan ahead for your refills. Don't wait until you are out to call your pharmacy to order a refill. Give the pharmacy a minimum of three days to get your refills ready.
- Arrange for privacy
If you want to hide the fact you take meds, arrange for some private time at work when you can take your meds. Scout out a place such as a bathroom where you can take your meds in private.
- Keep a diary
Write down successes as well as failures to remind you what has worked and what has not. Record missed doses to identify times or doses that need to be worked on to improve adherence.
- Establish and use a support network
Find friends or family that can assist you in taking your meds. Local "buddy lines" can help with reminders and serve as a partner in therapy. Realizing others are struggling as you are can help with feelings of isolation. Develop a working relationship with your healthcare team.
- Leave yourself notes and reminders
Leave notes around the house where you will be sure to see them; the refrigerator, next to the TV, and the bathroom mirror.
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