Therapy and Medication May Increase Adherence to HIV Treatment

Antiretroviral therapy (ART) is more available than ever before. In prior years, many individuals in developing regions were unable to afford or gain access to ART for the treatment of HIV. In fact, the number of people who are on ARTs in developing countries has increased from approximately 400,000 to over 8 million in just ten years. This increase is a positive step in the treatment and prevention of HIV.

However, many people still do not adhere to their ART regimen, which can lead to resistance, infection, and even death. In the United States, psychological issues such as anxiety, stress, and trauma have all been shown to be deterrents to adherence. In developing countries, financial, religious, and geographical restrictions may continue to present barriers to treatment.

Kathryn Whetten of the Center for Health Policy at the Duke Global Health Institute at Duke University in North Carolina wanted to capture a better picture of what factors impeded adherence to residents of developing countries. In a recent study, Whetten assessed surveys from 468 individuals with HIV living in Tanzania. The participants first completed the surveys during 2008 and were followed-up three years later.

Whetten found that the participants who remained most vigilant to their treatment protocols were those who had been on them the longest. This suggests that they may have developed a level of trust with their doctors, or perhaps been especially motivated to begin ART from the beginning.

“Similar to findings from our studies in the U.S., people reporting incomplete adherence endorsed prior exposure to more types of childhood potentially traumatic experiences, notably childhood sexual abuse,” said Whetten. Other factors that impeded treatment were death of a family member in childhood, depression, and abuse. Further, childhood traumas in general seemed to decrease the likelihood of adherence in this sample. But childhood sexual abuse had the largest impact. Additional factors that emerged were financial and religious barriers and stigma.

Whetten pointed out that contrary to the assumption that increased availability to medication will increase adherence, these results suggest that increased availability and ease of access may actually produce higher nonadherence rates. She believes that individuals with HIV would benefit greatly from psychosocial interventions that address psychological concerns, thus increasing their chances of ART adherence.

Reference:
Whetten, K., Shirey, K., Pence, B.W., Yao, J., Thielman, N., et al. (2013). Trauma history and depression predict incomplete adherence to antiretroviral therapies in a low income country. PLoS ONE 8(10): e74771. doi:10.1371/journal.pone.0074771

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  • connor t

    connor t

    October 23rd, 2013 at 11:53 AM

    I’m sorry but why on EARTH wouldn’t you stick with a program shown to have such measureable and beneficial results like taking your drugs to fight HIV? I guess I was a little shocked to read that there are actually people who don’t stick with their regimen and risk their lives as a result.
    If I know that this is going to extend my life, then I am going to do it. I know that money is often a deterrent for some but if this isn’t the issue, then it has to be just plain laziness. I am sure that if your drug regimen is making you feel sick then maybe your doctors could tweak it or something, anything other than just giving up on it.

  • louisa

    louisa

    October 24th, 2013 at 3:56 AM

    connor t- who are we to judge why anyone does wht they do?

    The fact of the matter is that if we want these patients to have longer life expectancies than what they have been given then there has to be ways that encourage them to stay true to their regimen.

    This may include building better relationships with their doctors or even having family members who become commited to the process as well.

  • Brett

    Brett

    October 24th, 2013 at 12:23 PM

    If someone is reticent about their drug regimane then why would we think that they would then adhere to a therapy program that was to encourage them to stay on that program? I mean, this goes deeper than that. There are probably some very deep issues that so many of these patients need to be dealing with but have chosen to ignore for a long time or they have been afraid to deal with for a long time. Therapy could be very useful, I agree, but are they going to be able to stick with that too?

  • Francine W

    Francine W

    October 27th, 2013 at 9:33 AM

    I have come to the conclusion over the course of many years of experience that those who wish to succeed will, and thos who do not will not. This is the kind of the same thing for me. For those who wnat to help themselves get better, then they will find a way to get access to the medicine that they need, get to their appointments and they will make their healthcare a priority in their lives, plain and simple. For those who ultimately don’t care, then they won’t and nothing is going to change this. This is just who they are, and if they aren’t all that concerned about it then I have come to the conclusion that I shouldn’t worry so much about it either. They are adults and their lives and their health is up to them, not to me, so unless I have a vested interest in it, I guess the ebst thing for me to do is just to sit back and stay out of it.

  • kyleigh

    kyleigh

    October 28th, 2013 at 4:00 AM

    The usual suspects holding people back from reacing their full potential are once again showing that they are holding these patients back as well. Depression, past abuses, those loss of a close family member or loved one, all of these things can combine to then make a less than compliant adult patient. So then what can you do? Awfully hard to change the past and the past experiences that this person has had.

  • anonymous

    anonymous

    October 29th, 2013 at 3:52 AM

    Has anyone thought about the fact that much of this is very expensive and if i had to choose between this or feeding my kids I am going to put food on the table first?

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