Eliminating barriers to HIV treatment adherence can improve outcomes
Some patients with chronic diseases struggle with medication adherence, but the high degree of adherence required to maintain viral suppression can represent a unique challenge for HIV patients.
Identifying the adherence barriers patients face can help providers find interventions to help achieve therapeutic success.
LEANDRO MENA, MD: You know, what are the most important factors in your practice that you think have an impact on adherence? Understanding that there are patient-specific factors, there are clinical factors, there are factors that are associated with the medications, and certainly there are factors that come from the patient-provider relationship.
What are the main factors in your practice and how do you help your patients understand or overcome these factors?
CYNTHIA RIVERA, MD: One thing that I like to focus on as well are other helath problems. So, clinical barriers to care. Perhaps somebody’s dealing with another chronic illness with other medications that may interact with medications that they’re taking. So, I like to make sure that that clinical history, not just on the medications, but are you feeling too sick to take your medications right now, how can we help optimize your health so that you are in a place where you can not only start taking the medications but remain adherent to the therapy?
DERRICK BUTLER, MD: Absolutely, and definitely the clinical situation. I can’t emphasize enough the social issues that those patients deal with. The reason I emphasize social issues in my clinic is because sometimes those issues become the priority. Versus their treatment, and they’ll say “Doc, I wanted to stay on my meds, but we got evicted from my apartment”, and so trying to help that patient bridge that gap towards adherence or at least try to tell them that, is there a way that we can, despite this obstacle, can you just take your medicine, is there a way we can help you do that?
CYNTHIA RIVERA, MD: The, okay, when times get rough, call me, because that’s where we can deploy resources, multidisciplinary apporach, a case manager, or people to help find those resources that then enable them to place priority on their health and not just the day and not the day-to-day problems that perhaps impact them financially and impede their ability to get their medicines filled at the pharmacy.
LEANDRO MENA, MD: You’re very right and you make another great point, which is, I mean, help the patient understand that we are a team. It’s not only one doctor giving a medication for you to take, but there is a whole support system out there. You have to be aware of which resources are available in your community, and as you identify these needs in your patients, the best thing you can do is refer them to those services.
DERRICK BUTLER, MD: Absolutelym and that ties into, like, the bigger picture, is that provider-patient relationship–that patient’s relationship with you, the provider, and your healthcare team so that the patient feels confident that you’re on their side, that they have help.
LEANDRO MENA, MD: I mean, even having all the support in the world to take care of all the patient’s social problems, but how you help them to change their priorities, that somehow, no matter how chaotic everything may be around, you take that medication. Sometimes I find useful to have my patients tell me about their daily schedule and how is on the weekday, how is on the weekends, and help them anticipate things that can happen. So, I advise them to usually carry with them, sometimes in a keychain, a couple pills so that way no matter where they are, they can actually take the next dose so they don’t have to rush, because, going back to what we had so many times, it’s about how this regimen, this treatment regimen, fits into their life and not about modifying their lives that they have in order to have to take a medication every day.
CYNTHIA RIVERA, MD: Very well stated.