Adherence
Posted by Pozziepinoy on 12:36 PM
I know that I've already discussed this before in my previous entries but I want to have another entry about adherence and it's importance. It is not easy to have this discipline and I have been a witness to a lot of pozzies who claimed that they up to now, even after taking ARV's for months or years, have either missed or skipped intakes one time or two or sometimes more days in a month.
I found this adherence program in the internet but I don’t know the source. I hope it would be ok to repost it in my blog as I know the purpose of this article is to educate persons with HIV/AIDS like what I am doing also in my blog.
ARV ADHERENCE
This program is about adherence to antiretrovirals. For HIV treatment to be effective, good adherence is very important. Good adherence means taking all your antiretroviral medicines every day, at the right time
and with food if necessary. Poor adherence can have very serious consequences.
CHAPTER ONE: WHAT IS ADHERENCE?
- For HIV treatment to be effective, good adherence means taking all your ARV medicines, every day, at the right time.
- Good adherence is important with most medicines, but it’s absolutely vital with antiretrovirals.
- When we start taking antiretrovirals, we stop HIV from making copies of itself. This gives the immune system a chance to recover.
- As the viral load goes down, the number of CD4 cells goes up. When our adherence is good and our antiretroviral treatment is working, our viral load can become 'undetectable'. Undetectable does not mean the virus has gone. It just means that the amount of virus in our blood is too small to be measured (less than
50 copies per tiny drop of blood).
- When you start ARVs, you take a combination of at least three different ARV drugs. Sometimes this is called triple therapy or HAART (Highly Active Antiretroviral Therapy). The three drugs together form your ARV regimen. The first ARV regimen that you will take will probably be Nevirapine, 3TC and d4T (or Efavirenz instead of Nevirapine).
CHAPTER TWO: WHY GOOD ADHERENCE IS IMPORTANT
- If your adherence is bad, the HIV in your body becomes drug-resistant (it learns to fight the drugs).
- ARVs stop HIV from making copies of itself. Taking our pills on time is important because if we miss a dose, the virus immediately takes advantage and starts to replicate itself again. These copies will be a little bit different and the ARVs will be less effective against this changed virus.
- With HIV, avoiding resistance is very important. The only way to treat drugresistant HIV is to move on to a different combination of ARVs. We call this a new regimen. In South Africa at present, there are only two regimens available in the public sector.
- HIV that is resistant can be passed on to someone else and the drugs will not work for that person either.
Summary: Why Is Good Adherence Important?
- You can become drug resistant with bad adherence.
- Resistant HIV can stop ARVs from working effectively against HIV.
- Resistant HIV can be passed onto someone else.
- The only way to treat resistant HIV is to change ARV regimens.
- There are only two ARV regimens in the South African public health sector.
- You should try to stay on one regimen for as long as possible.
- Good adherence will mean you have a good chance of doing this.
CHAPTER THREE: WHY IS SOME PEOPLE'S ADHERENCE POOR?
- It is important to look carefully at what makes it easy for us to take our pills properly and to tackle those things that make it more difficult.
- If you experience side effects from ARVs, remember that you must not stop treatment by yourself. You must go back to your health worker and they can help you.
- Many things can make it difficult to be adherent, such as:
- depression
- not having disclosed your HIV status
- using alcohol or drugs
- sometimes clinics or hospitals run out of ARVs
- sometimes people have to travel a long way to the clinic or hospital where they get their pills.
- You must not share pills. If we give half our pills to someone else:
• the ARVs will not work for us
• the ARVs will not work for the other person
• we will develop treatment-resistant HIV
- fewer and fewer ARVs will work for us.
- It is very important that everyone who needs treatment tests and gets their own ARVs. It is much easier to do this if you've disclosed your illness to someone you trust. If you want to get ARVs from your local clinic, you should have someone you have disclosed to who can help you remember to take your pills.
CHAPTER FOUR: STRATEGIES FOR GOOD ADHERENCE - DEALING WITH
SUBSTANCE ABUSE.
- One of the problems with alcohol is that it can cause liver damage. Excessive drinking can also damage other aspects of your health. So, on one hand you are helping yourself by taking ARVs, and on the other, you are damaging yourself by drinking excessive alcohol.
- If you are too much into alcohol you are likely to engage in unprotected sex and might end up passing the virus on to other people. This is very bad for society as a whole.
- Drinking a lot can also affect your adherence.
- Excessive drinking can lead to a lot of problems. That’s why we encourage not only those who are on ARVs - but each and every HIV positive person - to stay off excessive alcohol. We must assist and support people who struggle with this to overcome their drinking problem.
Summary – Dealing With Substance Abuse:
- Substance abuse weakens the immune system.
- Substance abuse makes us vulnerable to HIV and other opportunistic infections (OI’s).
- Substance abuse can reduce your ARV adherence.
- Do not be afraid to seek help and support.
- You can overcome substance abuse.
CHAPTER FIVE: STRATEGIES FOR GOOD ADHERENCE - DISCLOSURE
- The strategy that helps good adherence the most is disclosure and as much openness about your HIV status as possible.
- Disclosing our HIV status is good because it helps us get support and makes good adherence easier. Also, it is usually a great relief to tell someone else that we are living with HIV. It is much less stressful to be open, and reducing stress actually helps our health.
- Disclosing is when you as an HIV positive person decide that you can handle telling somebody else. In simpler terms, disclosing is telling someone that you have HIV.
CHAPTER SIX: STRATEGIES FOR GOOD ADHERENCE – HAVING A
TREATMENT SUPPORTER
- Having a treatment supporter can really help with adherence, particularly if a person does not have enough support at home. That is why home visits are so important as well.
- During home visits the family is also educated. An educated family will play a big role in helping someone, like reminding you to take your medication on time etc. Having a treatment supporter is important as when people don’t have a treatment supporter or general support from the family, they are more likely to be nonadherent to their treatment.
- A person can be asked to bring along a treatment supporter to counselling
sessions so that they can have some kind of support.
CHAPTER SEVEN: STRATEGIES FOR GOOD ADHERENCE - OTHER IDEAS
- There are many factors that make good adherence difficult. Fortunately there are also many things we can do to make it easier.
- We must be creative when looking for ways to remember our pills, such as:
• Watching a specific show on television or the radio and every time you watch it you remember that’s when you’re supposed to take your pills.
• Using a pillbox.
• Setting reminders on your phone.
• Asking friends to phone you or remind you.
• Make taking your pills every day at the right time part of your daily routine.
Conclusion:
We have learnt about the importance of good adherence - taking all your pills everyday at the right time. We’ve seen how poor adherence causes resistance, which means that the treatment stops working. We have looked at the different factors that can cause poor adherence - such as alcohol abuse, experiencing side effects, lack of disclosure, and lack of full support from health services.
Disclosure is a particularly important issue. Now that there is effective treatment for HIV, secrecy and fear have become the most dangerous aspects of the illness. Secrecy and fear are more effective killers than the virus by itself.
I hope this will enlighten my co pozzies about ARV adherence. You can all start a good adherence plan and start working on it NOW.
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