AllLife’s Medical Director, Dr Avron Urison says that the prescription of medicine is an essential component of the delivery of health care, given its function to not only relieve symptoms or cure conditions but also to prevent poor health in the future. Consequently, there is a need for thorough adherence counselling, so as to guide people living with HIV, particularly in South Africa, on how they can keep HIV under control and lower the risk of developing viral resistance.
In the same light, Urison stated that incorporating a behavioural element to adherence interventions, for HIV-positive South Africans who are on treatment, has the potential to increase effectiveness. This is due to the fact that educational efforts alone are not enough to promote adherence to medication, especially in people living with HIV.
“Generally, improving how people take their medication has a far greater impact on clinical outcomes than an improvement in treatments,” he said. “In the case of people living with HIV, they need to be helped to understand that missing medication doses regularly, or changing the time medication is taken, enables the virus to defeat the ARVs sooner.”
Intentional and unintentional non-adherence
“Non-adherence is a hidden problem because many people are reluctant to express doubts or concerns about the medication prescribed to them fearing that it will displease their doctors,” said Urison. “As such, it is the duty of the medical practitioners to always explain the purpose of the treatment to the person living with HIV, and openly discuss the pros and cons of proposed medicines.”
He said that, in turn, the HIV-positive person should always disclose to their doctor’s factors such as difficulties with reading or speaking English, physical or learning disabilities, as well as sight or hearing problems which may affect their understanding of how they should correctly take the medication.
Furthermore, Urison recommended that people, in general, need to understand that there are two categories of non-adherence; intentional and unintentional. Intentional non-adherence occurs when the person decides not to follow the treatment recommendations.
On the other hand, unintentional non-adherence occurs when an individual intends to follow the doctor’s recommendation of taking a certain number of pills at a specific time. However, this invention is prevented by uncontrollable circumstances such as poor understanding of instructions or simply forgetting to take it.
“The South African government has made a number of efforts aimed at fighting HIV/AIDS in the country; in so doing, saving lives and improving the quality of life for South Africans living with HIV,” said Urison. “Amongst those efforts is reducing the pill burden of the first-line regimen to one pill a day, so as to improve adherence levels.”
“However, we need to evaluate the existing stumbling blocks so as to lead to an increase in adherence and improvement in treatment effectiveness; such improvements should include promoting open discussions about medicines and adherence practices and long term benefits.”