Adherence

Question 1

What are 3 main benefits to suppressive ART treatment

Answer 1

1. For the individual the HIV becomes a manageable chronic illness
2. For the sexual partners the risk of transmission is removed
3. For the country, the population become healthy and there is a decrease in the reliance on public health

Question 2

What is the U=U theory

Answer 2

This is the fact that people who take their ART daily develop undetectable viral loads and this means that they have effectively no risk of sexually transmitting the virus

Question 3

What are the 3 main difficulties related to ART adherance

Answer 3

1. Choice to start ART [Initiation]
2. Taking the daily dose of the medication [Implementation]
3. The need for a long term relationship with the health system [persistance]

Question 4

What is the 90 90 90 strategy in antiretroviral therapy

Answer 4

It aims to achieve three primary goals:

90% of all people living with HIV should know their HIV status – Ensuring widespread testing and awareness of HIV status.

90% of those diagnosed with HIV should receive sustained antiretroviral therapy – Ensuring that those who know they are HIV-positive have access to continuous and effective ART.

90% of those on ART should achieve viral suppression – Ensuring that ART is effective, with patients reaching an undetectable viral load to reduce transmission and improve individual health.

Question 5

What are the 4 main steps in achieving viral suppression

Answer 5

1. Diagnose
2. Start ART
3. Keep people in care
4. Keep people virally suppressed

Question 6

What are 4 methods for monitoring adherence

Answer 6

1. Subjective adherence: This is where the patient is asked about their adherance and self reports
2. Pill counts: This is where a patients remaining pills are counted at the next visit
3. Electronic metods; Smart bottles are used that record when they are oppened
4. Drug concentrations: This is when biological markers are tested in the blood or urine

Question 7

What are 4 strategies that have been shown to improve adherence

Answer 7

1. Education and counselling methods
2. Electrical interventions
3. Health system restructuring
4. Economic based interventions

Question 8

What are some of the electrical tools that aid in improving adherence

Answer 8

1. Mobile phone interventions: The are weekly or daily calls or SMS to improve adherence
2. Electronic monitoring devices: Smart Pill Bottles

Question 9

What are some of the barrier that are related to health system that influence adherence

Answer 9

1. Long travels to clinics
2. Long wait times at the clinics
3. Clinics being out of stock
4. Negative interactions with staff