Skip to Content

Medical Services : Adherence Program

The advent of highly active antiretroviral drug therapy (HAART) has changed the lives of people living with HIV/AIDS. Southwest CARE Center has recognized that maintaining challenging medication schedules and regimens is the most important issue facing clients. This challenge is commonly referred to as "adherence." Non-adherence is the primary preventable cause of viral-load breakthrough leading to impaired health and death from HIV disease. The reasons given by HIV-positive clients for missing medication doses indicate that a formalized adherence program has a significant impact on client health. In 1999, the Center adopted a formal adherence program guided by the Multi-Disciplinary Team (MDT).

The guiding principle of the program is that the client is the most vital member of the adherence team. Central to the Center's adherence model is an individualized adherence treatment plan developed with the client and tailored to the client's lifestyle. Clients are empowered through negotiation of the adherence plan to take charge of their health care and medications.
A specific adherence role has been developed for each member of the client's MDT. The roles are designed to be integrated in an effort to enhance the client's success. The roles are as follows:

  • The physician is responsible for diagnosing and treating the disease; discussing the goals of treatment; explaining the importance of adherence; motivating the client to want to adhere to the medication schedule; acknowledging to the client the challenges and difficulties of adhering to a complex schedule; forewarning the client about the potential side effects; enlisting the client as a partner in the implementation of the treatment plan; and communicating with the MDT when adherence issues are identified.
  • The nurse works with the client to develop the client's understanding of the potential impact of missing medication doses; to develop a daily medication schedule with the client; to explain medications and side effects; to provide medication tools and educational aids; to communicate with the MDT when adherence issues are identified; to provide information regarding interactions with other prescriptions, over-the-counter drugs, and foods. In addition, the nurse is responsible for contact with the client prior to the first weekend on a new regimen; providing follow-up and support regarding the medication schedule at every appointment; managing side effects; and referring the client to a dietitian as needed.
  • The social worker works with the client to explore adherence readiness; to identify potential barriers to adherence; to develop individualized adherence plans; to assist the client in optimizing his or her medication regimen with his or her personal schedule; to find solutions to barriers; to develop more positive coping strategies; to communicate with the MDT when adherence issues are identified. In addition, the social worker is responsible for developing with the client a Wellness and Health Management Plan that addresses psychosocial challenges to adherence and overall self-care.