In order for people who are HIV positive to lead a healthy life, there is a need for them to consistently take their medication-antiretroviral drugs (ARVs) in this case-and also following instructions as given to them by their physicians. 

This can be termed as medication adherence which means the ability of the patient to take medications as prescribed by their physician with regards to the correct drug, dose, route, timing, and frequency.

Why this is important 

When it comes to ARVs, adherence with the prescribed regimens is very important for proper viral suppression to be successful, medics explain.

Antiretroviral drugs prevent HIV from multiplying, so skipping medication would allow the virus to multiply which increases the risk of the virus to mutate and produce drug-resistant HIV.

Prosper Dusengeyezu, a public health officer at Rwanda Pharmaceutical Students’ Association (RPSA) says when it comes to HIV management, a patient needs to become an active agent in the treatment process. They are expected to assume responsibility in taking the medication or following the health recommendations, he says.

"This is why patients are also urged to request information regarding their health status and to also participate in decision-making during treatment.”

Adherence is about a person’s commitment to taking medication, following a diet and/or executing lifestyle changes, that correspond with the agreed recommendations from a health care provider. This is why treatment depends on the patient’s will and interest in maintaining or improving their health status, he explains. 

According to Boniface Nsekanabo, a medic at AVEGA Clinic in Remera, Antiretroviral Therapy (ART) has proven to be the most effective treatment method for people living with HIV.

He, however, notes that its effectiveness critically depends on the extent of individual medication adherence.

For instance, he says when the rate of adherence to medication is as high as 95 percent, the viral suppression rate approaches 78 percent.

However, he says when the rate of adherence is reduced to 80 percent; there is a dramatic reduction in the viral suppression rate, which can be as low as 20 percent.

Experts say the adherence rate of medication should be maintained at 95 percent or above to optimize antiviral outcomes and enhance viral suppression.

He notes that people should know that good adherence will always give a positive outcome as far as HIV treatment is concerned. For instance, he says adherence is significantly associated with lower viral load, and that is also associated with elevated CD4 cell count.

Poor adherence to medication has been confirmed to be a risk factor for the emergence of drug-resistant HIV strains, which can be transmitted to others.

"Poor medication adherence not only endangers individual health but also increases risks of transmission with detectable viral loads, brings difficulties in treatment, leading to severe public health problems,” he adds.

Dusengeyezu explains that the percentage of adherence is equal to dispensed minus returned, divided by an expected amount to be taken multiplied by percent.

This, he says, will give you the value of adherence and with it; a patient can guide the healthcare provider to take the decision for the patient in regards to the treatment progress.

Why some patients fail to adhere

The medic says both adherence and observance are important factors for the success of treatment. 

He notes that some of the factors that influence adherence include those linked to the patient, health care provider, as well as treatments and the drugs.

For those linked to the patient, Nsekanabo says include forgetfulness, preparation, and motivation of the patient, negligence, being far from home, lifestyles (alcohol abuse, depression among others.

Some he says could be socio-economic issues (isolation, insufficient support, unemployment, and fast work pace, nutrition deficiency among others.

Those related to the health care provider include; preparation of the health care provider (knowledge, skills), education of and communication with the patient, he says.

Complications

Optimizing adherence, especially in the early phase of treatment, is crucial to sealing long-term immunological and virological success.

However, the lack of adherence to treatment has multiple consequences not only for the patient but for the state.

Some of the effects Dusengeyezu says are increased expenses for hospitalization, absenteeism, care for opportunistic infections, and changes in treatment schemes and laboratory studies.

He also says lack of adherence increases the risk of HIV transmission in populations and the development of new strains resistant to treatment.

Dusengeyezu says non-adhering with people living with HIV always comes with complications, of which when left unhandled, can bring more harm to the patient.

editor@newtimesrwanda.com