Treatment Adherence

Treatment adherence picture

Drug adherence is a key part of  antiretroviral therapy (ART). It refers to the whole process from choosing, starting, managing to maintaining a given therapeutic medication regimen to control HIV viral replication and improve function of the immune system. 

Non-adherence is the discontinuity or cessation of part or all of the treatment such as dose missing, under dosing, or overdosing, and drug holidays.1 The significance of adherence to treatment has become recognized, which is important in optimizing the patient's response to therapy. In contrast, non-adherence can lead to treatment failure, a rise in plasma viral load, and the development of drug-resistant HIV strains. This chapter is devoted to a description of a practical drug adherence programme, modeled on the protocol developed at the Integrated Treatment Center, Department of Health.

The four-stage approach in drug adherence counselling

Stage one: general preparation

This stage serves to determine treatment readiness, characterize potential and actual barriers to adherence, and provide relevant treatment knowledge and educational interventions. A trusting and caring relationship between health care provider and patient have to be established in order to achieve mutual understanding of the treatment goal.

Stage two: treatment initiation

The most important time to address the importance of adherence to treatment and medication regimens is before starting therapy. Patient's commitment to medication adherence should be assessed. Before ART is begun, the risks and benefits of treatment must be discussed.

Stage three: consolidation

The initial phase of starting treatment is a critical period for the patients in establishing the confidence and adopting a drug taking behavior. They may be unfamiliar with the treatment schedule and encounter adverse effects. The support of the healthcare worker is important for enhancing patient drug adherence and their management of adverse effects.

Stage four: maintenance

When the ART regimen is stabilized, frequent and regular monitoring of drug adherence is important to maintain optimal behavior. The nurse counselor measures and assesses adherence on an ongoing basis to allow comparison of a given patient's adherence across time. This also serves as opportunity to evaluate side effects, identify barriers and provide support and reinforcement to patient. The objectives of maintenance counselling are:

  • to optimize patient's adherence to ART
  • to reinforce patient's drug taking behavior




American Public Health Association. Adherence to HIV Treatment Regimens: Recommendations for Best Practices. Wahington DC: APHA, 2004. Available from (accessed 25 April 2006).

World Health Organisation. Chronic HIV Care with ARV Therapy. Interim Guidelines for First-Level Facility Health Workers. Integrated Management of Adolescent and Adult Illness(IMAI). Geneva:WHO, 2003. Available from (accessed 25 April 2006).

Aidsmap. Interventions to Improve Adherence. Available from (accessed 25 April 2006).

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