Which simple adherence interventionswork best for people with HIV?

摘要

Industrious behavioral and clinical researchershave devised and tested a daunting array of strategies toimprove antiretroviral adherence. Busy clinicians cannothope to wade through the literature assessing theseinterventions to find simple strategies that work for theirpatients, but expert teams have narrowed the field bydint of careful collaborative analysis. Routine viral loadmonitoring and questions designed to elicit accurateself-reports rank as the most basic adherence-gaugingtools—though viral load testing has its limits. Startingor switching to convenient and safer contemporaryregimens has become a standard of adherencepromotingcare. Diagnosing and treating depression andguiding substance users into drug treatment programshave proved their value in bolstering adherence. TheCDC offers a list of carefully scrutinized evidencebasedinterventions that boost antiretroviral adherence,including brief and ongoing provider-patient exchangesand an interactive computer program. Pretreatment pilltakingpractice and text-message reminders could havean adherence-enhancing role for some patients.