Adherence Strategies That Can Work for You

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 medications. The method by which antiretroviral medications suppress the HIV virus necessitates a very strict regimen of medication. Drugs must be taken exactly as prescribed without missing doses if they are to work to their full potential. Sounds easy enough, right? Wrong! Between medication side effects, emotional issues surrounding therapy, and concerns about confidentiality, adherence can be very difficult. In order to be more adherent, first we need to know why people don't take their medicines.

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

_{Statistics from Adherence to HAART, 1997}

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.