ABSTRACT
Since the early days of antiretroviral therapy, adherence has emerged as the milestone of success; in fact, it is the most potent predictor of effectiveness. The main factors related to adherence include the complexity of the therapeutic regimen, adverse effects, psychological problems, alcoholism and active addiction to drugs, lack of social and family support and the patient's beliefs and attitudes about the treatment. Adherence monitoring should be part of the HIV patient's regular care, and should be done with feasible, easily applied methods adapted to the different clinical settings. The minimally acceptable measures should include use of a validated questionnaire, together with data from the Pharmacy Department's drug dispensation registry. All patients that begin HAART or undergo a change of treatment should participate in a treatment education program imparted by health professionals with knowledge and experience in the management of patients with HIV infection. The health team (doctors, pharmacists and nursing professionals) should offer maximum availability to solve the doubts and problems that may occur during treatment. When sub-optimal adherence is detected, intervention strategies based on psychological therapy, educational efforts and personal advice should be attempted, in order to adapt the treatment scheme to the patient's habits and provide solutions to the problem of non-compliance. In certain situations, co-morbid conditions will also require attention. Treatment adherence, being a multidimensional problem, needs a multidisciplinary team approach. The choice of therapy, only one aspect of the multidimensional problem of adherence, must be a careful and individualized decision; however, simpler regimens with regard to the number of pills and daily dose are desirable.
Subject(s)
Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , HIV Infections/drug therapy , Patient Compliance , Algorithms , Anti-HIV Agents/administration & dosage , Anti-HIV Agents/adverse effects , Anti-HIV Agents/blood , Attitude , Attitude of Health Personnel , Drug Administration Schedule , Drug Packaging/instrumentation , HIV Infections/complications , HIV Infections/nursing , HIV Infections/psychology , Health Knowledge, Attitudes, Practice , Humans , Mental Disorders/complications , Mental Disorders/psychology , Motivation , Nurse's Role , Patient Acceptance of Health Care , Patient Care Team , Patient Education as Topic , Physician's Role , Professional-Patient Relations , Psychological Techniques , Substance-Related Disorders/complications , Substance-Related Disorders/psychology , Surveys and QuestionnairesABSTRACT
El cumplimiento incorrecto del tratamiento antirretroviral(TAR) constituye el factor principal de fracaso terapéutico. Los factores que han demostrado estar relacionados con la adherencia de forma más relevante incluyen la complejidad del tratamiento, los efectos secundarios, los problemas psicológicos, la adicción activa a drogas y/o alcohol, la falta de soporte socio familiar y las actitudes y creencias del paciente acerca del tratamiento. La monitorización del cumplimiento debe formar parte de la atención habitual del paciente con infección por el virus de la inmunodeficiencia humana (VIH), deben utilizarse métodos factibles, adaptados a la realidad del hospital y lo más universalmente aplicables. Puede considerarse un mínimo aceptable la asociación de un cuestionario validado y el registro de dispensación del servicio de farmacia. Todo paciente que inicie o cambie el tipo de TAR debe realizar un programa de educación sanitaria sobre el tratamiento, a cargo de profesionales sanitarios con experiencia y conocimiento del manejo de pacientes con infección por VIH. Debe procurarse la máxima disponibilidad del equipo asistencial (médicos, farmacéuticos y profesionales de enfermería) para resolverlas dudas y problemas que se presenten a lo largo del tratamiento. En los pacientes en los que no se alcancen niveles de cumplimiento adecuados, se deben intentar estrategias de intervención, basadas en aspectos psico-educativos y de asesoramiento personal, con capacidad para adaptar el esquema del TAR a los hábitos de vida del paciente y proporcionando estrategias de resolución de problemas. En determinadas situaciones será necesario resolverla comorbilidad, por lo tanto el enfoque debe ser pluridisciplinar. Son aconsejables pautas más sencillas en cuanto a número de comprimidos y a dosis diarias (AU)
Since the early days of antiretroviral therapy, adherence has emerged as the milestone of success; in fact, it is the most potent predictor of effectiveness. The main factors related to adherence include the complexity of the therapeutic regimen, adverse effects, psychological problems, alcoholism and active addiction to drugs, lack of social and family support and the patients beliefs and attitudes about the treatment. Adherence monitoring should be part of the HIV patients regular care, and should be done with feasible, easily applied methods adapted to the different clinical settings. The minimally acceptable measures should include use of a validated questionnaire, together with data from the Pharmacy Departments drug dispensation registry. All patients that begin HAART or under go a change of treatment should participate in a treatment education program imparted by health professionals with knowledge and experience in the management of patients with HIV infection. The health team (doctors, pharmacists and nursing professionals) should offer maximum availability to solve the doubts and problems that may occur during treatment. When sub-optimal adherence is detected, intervention strategies based on psychological therapy, educational efforts and personal advice should be attempted, in order to adapt the treatment scheme to the patients habits and provide solutions to the problem of non-compliance. In certain situations, co-morbid conditions will also require attention. Treatment adherence, being a multidimensional problem, needs a multidisciplinary team approach. The choice of therapy, only one aspect of the multidimensional problem of adherence, must be a careful and individualized decision; however, simpler regimens with regard to the number of pills and daily dose are desirable (AU)
