Common barriers to adherence

There are just a few generalisations about non-adherence that seem to hold up in many studies and across different cultural and economic groups. These are an absence of social support, the difficulty and inconvenience of a regimen, symptoms and adverse drug effects, belief in one’s ability to stay on therapy, and stressful life events.¹

Researchers have identified the following barriers to adherence:

• The caregivers' incomplete knowledge of the demands of patients' lives
• Prejudice
• Insufficient appointment time
• Lack of resources for patients who have doubts or questions
• Negative stereotypes about doctors
• Insufficient multi-disciplinary communication.^{2 3}

Beyond these barriers, in each new setting where ART is to be offered, interventions to help with adherence need to be targeted to the specific population of patients who will be starting treatment. This may involve focus groups and/or interviews with patients to troubleshoot potential problems and to track changing adherence issues over time.

Two very common barriers to adherence are thought to be the number of pills that need to be taken and the number of times a day pills must be taken. To test that theory, researchers looked at eleven randomised, controlled trials (with over 3000 participants) and evaluated adherence rates seen with once-daily versus twice-daily medication regimens.

Overall, once-daily dosing regimens resulted in a significant improvement in the proportion of patients with undetectable viral load. In particular, treatment-naive patients on once-daily dosing regimens had a better adherence rate than those on other regimens.⁴ Conversely, there was a slight worsening of treatment outcomes amongst treatment-experienced individuals who switched to once-daily regimens, but this may be more reflective of the tolerability, potency, and resistance potential of those regimens.

Each time a regimen is changed, review of the new dosing schedule and its integration into the patient's daily routine should be discussed.