By Ashraf Grimwood (Kheth'Impilo, South Africa)
“I can't even complete a full course of antibiotics, how am I going to remember to take my ART?”
Adherence is usually understood to mean ‘the taking of medication as prescribed’ at the correct time and with the correct association with meals. But managing HIV infection is more than just about taking pills – adherence is about sticking to positive lifestyle choices.
The impact of HIV starts from the time of infection and earlier treatment will go a long way in avoiding complications. But before starting treatment it is important to be mentally ready and prepared. I always recommend to my patients that soon after diagnosis, regardless of how they feel, counselling is vital. The usual response is, “What would I talk about? I know how I got infected and I know what I need to do!” I say, “Just go. Talk about anything, give time to connect with the why and the how, understand your feelings and see if you can use this positively.”
The best way of managing an HIV infection is about making the right lifestyle choices and, critically, adhering to these. Adherence is about following lifestyle choices - irrespective of what they may be - that ensure the best health outcomes. Regular monitoring, CD4 counting, STI testing, exercise and a good dietary plan are crucial for good health maintenance before even starting to take pills.
Combination antiretroviral treatment is the best known way of controlling the virus. Pills need to be taken as directed by a clinician. It is important that personal lifestyle is discussed with a health care worker to ensure there is no clash. “How do I take my pills when… I work shift work? I travel often? I take recreational drugs? I am addicted to heroin? I am on methadone? I am pregnant? My partner does not yet know I am HIV positive?” These all need to be discussed with a health care practitioner. It is important to talk through any life issues that might impact on treatment adherence. Open honest communication is always the best option to ensure better health outcomes.
When starting treatment it is important to know what is being prescribed – learn the names, understand what they do, how they work, what their side effects are and when to seek professional advice. Ensure treatment is taken at the times prescribed and know how much leeway is acceptable with regards to the timing so the margin of safety is known when travelling across time zones or working shifts.
Any day forgotten gives the virus an opportunity to rebound and any resistant strain to dominate. This can lead to multi-drug resistance and treatment failure. Treatment failure means new drugs need to be prescribed. All these treatments have different side effect profiles which need different management. It is best to remain on the initial prescribed regimen if there are no adverse effects.
There are many tools that can be used to act as reminders for taking pills on time. Using a daily treatment tick-sheet or diary, pill boxes, and cell phone reminders are a few techniques that people have found work for them. Some take their daily ART at night after brushing their teeth, so they are often kept where this is done. Some have spare pills at their workplace. Packing pill boxes once a week or getting blister pre-packs for the month are other strategies that have worked for some.
All people living with HIV today have the opportunity to lead as normal lives as possible with this infection – and adhering to medication and selected lifestyle choices is often the starting point. No doubt it’s hard to stick to these. But being honest with ourselves and with our clients is always a great start.
Article from IPPF HIV Update newsletter - Issue 24: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+24.htm