HIV Treatment Adherence, Patient Literacy, and Communication
HIV Treatment Adherence, Patient Literacy, and Communication
Background: Little is known about patients' health literacy regarding antiretroviral therapy (ART) adherence and drug resistance and patient–provider communication about these topics.
Design and Methods: The AIDS Treatment for Life International Survey was a multicountry cross-sectional study (January-March 2010) including 2035 HIV-infected adults. A 40-minute interview was conducted using a standardized self-report adherence questionnaire.
Results: Overall, 57% of patients reported a 30-day recall of 100% adherence (Latin America: 89%; Africa: 73% vs North America: 45% and Asia Pacific: 47%; P < .01). Overall, 18% identified HIV drug resistance as a "good thing" in North America (35%) and Africa (24%). Only 71% said their health care providers had offered practical recommendations about adherence, 62% of the patients in North America and 80% in Latin America and Africa.
Conclusions: Optimal ART adherence remains a challenge globally. There is a critical need to improve patient–provider communication about the importance of ART adherence and its benefits for patient's health.
It is now widely appreciated that adherence to antiretroviral therapy (ART) is a critical determinant of HIV treatment outcomes. Indeed, adherence to ART has been shown to be an important predictor of achieving adequate suppression of HIV replication, which is required to minimize the emergence of HIV drug resistance (DR), slow disease progression, and delay death.
More recently, the importance of ART adherence was magnified in pre-exposure HIV prophylaxis (PrEP) trials, documenting that highly adherent patients had a higher likelihood of not acquiring HIV infection. Similar findings with respect to both test-and-treat and treatment as prevention (TasP) indicate the Achilles' heel of any antiretroviral-based intervention—whether therapeutic or preventative—is suboptimal adherence. Such treatment and prevention strategies are critical to augment the ongoing scale-up of access to antiretroviral-based interventions around the world, which is a major global challenge in the fight against HIV/AIDS. Successful scale-up depends upon many factors, including political will and financial resources, as well as local infrastructure, and health care capacity. These factors are important for delivering services and for promoting, monitoring, and enhancing adherence. Furthermore, required aspects of infrastructure include not only mechanisms to obtain and dispense drugs but also to educate patients and health care providers (HCPs) about how to manage adverse effects, maintain adherence, and implement lifestyle modifications to improve treatment and prevention outcomes.
Only limited data are available on a global scale about patients' health literacy and patient–provider communication related to HIV treatment adherence and HIV DR. The availability of such information would enable development and implementation of simplified, standardized treatment adherence and monitoring guidelines to be used by HCPs in ART programs worldwide, including in developed world settings, as appropriate. To fill this gap, we conducted the AIDS Treatment for Life International Survey (ATLIS) in 2010, with the aim of taking a worldwide snapshot of patients' reported ART adherence levels, patient health literacy, and HCP-patient communications on issues related to ART adherence.
Abstract and Introduction
Abstract
Background: Little is known about patients' health literacy regarding antiretroviral therapy (ART) adherence and drug resistance and patient–provider communication about these topics.
Design and Methods: The AIDS Treatment for Life International Survey was a multicountry cross-sectional study (January-March 2010) including 2035 HIV-infected adults. A 40-minute interview was conducted using a standardized self-report adherence questionnaire.
Results: Overall, 57% of patients reported a 30-day recall of 100% adherence (Latin America: 89%; Africa: 73% vs North America: 45% and Asia Pacific: 47%; P < .01). Overall, 18% identified HIV drug resistance as a "good thing" in North America (35%) and Africa (24%). Only 71% said their health care providers had offered practical recommendations about adherence, 62% of the patients in North America and 80% in Latin America and Africa.
Conclusions: Optimal ART adherence remains a challenge globally. There is a critical need to improve patient–provider communication about the importance of ART adherence and its benefits for patient's health.
Introduction
It is now widely appreciated that adherence to antiretroviral therapy (ART) is a critical determinant of HIV treatment outcomes. Indeed, adherence to ART has been shown to be an important predictor of achieving adequate suppression of HIV replication, which is required to minimize the emergence of HIV drug resistance (DR), slow disease progression, and delay death.
More recently, the importance of ART adherence was magnified in pre-exposure HIV prophylaxis (PrEP) trials, documenting that highly adherent patients had a higher likelihood of not acquiring HIV infection. Similar findings with respect to both test-and-treat and treatment as prevention (TasP) indicate the Achilles' heel of any antiretroviral-based intervention—whether therapeutic or preventative—is suboptimal adherence. Such treatment and prevention strategies are critical to augment the ongoing scale-up of access to antiretroviral-based interventions around the world, which is a major global challenge in the fight against HIV/AIDS. Successful scale-up depends upon many factors, including political will and financial resources, as well as local infrastructure, and health care capacity. These factors are important for delivering services and for promoting, monitoring, and enhancing adherence. Furthermore, required aspects of infrastructure include not only mechanisms to obtain and dispense drugs but also to educate patients and health care providers (HCPs) about how to manage adverse effects, maintain adherence, and implement lifestyle modifications to improve treatment and prevention outcomes.
Only limited data are available on a global scale about patients' health literacy and patient–provider communication related to HIV treatment adherence and HIV DR. The availability of such information would enable development and implementation of simplified, standardized treatment adherence and monitoring guidelines to be used by HCPs in ART programs worldwide, including in developed world settings, as appropriate. To fill this gap, we conducted the AIDS Treatment for Life International Survey (ATLIS) in 2010, with the aim of taking a worldwide snapshot of patients' reported ART adherence levels, patient health literacy, and HCP-patient communications on issues related to ART adherence.
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