Conclusion and future directions

The ability of people with HIV to adhere to treatment can be a complex matter, influenced by a wide range of individual, system-related, psychosocial and socio-political factors.

Nursing strategies to encourage, improve and maintain adherence include discussing potential antiretroviral therapy regimes with consideration to side-effects, simplification, lifestyle, comorbidities, and family history; evidence surrounding early treatment and continuing therapy once commenced.[43] [44] [45] Addressing social stigma related to revealing HIV status during adherence counselling sessions can be effective in helping to improve adherence.

Given the impetus towards treatment as prevention (TasP), and the success of international studies demonstrating daily antiretroviral therapy used as pre-exposure prophylaxis (PrEP), the role of the nurse in supporting adherence to antiretroviral therapy extends not just to ongoing support to those living with HIV but to a greater role in biomedical HIV prevention as well.[46] (See Section 14 Biomedical HIV prevention for more information).

At the systemic and socio-political level, nurses can contribute through research, policy development and structural advocacy to the development of systems that support health promotion, and access to and equity within health care, so that all people with HIV will have equitable chances of optimising their adherence to antiretroviral therapy and thereby maximising their health.

For other useful resources, see:

Adherence - Case example

Bert is a 43-year-old gay man who was diagnosed with HIV seven years ago.  He had held a firm belief that HIV medications were 'toxic' and preferred to use complementary therapies, vitamin supplements, and meditation. He became unwell following a psychotic episode and was hospitalised and diagnosed with cerebral toxoplasmosis.  He started antiretroviral therapy in hospital and was discharged home with a referral to an HIV community-nursing service.

Bert accepted visits reluctantly and suspiciously, anticipating that the HIV community-nursing team would lecture him and seek to impose a biomedical model of care on him and intrude upon his life. The HIV community nurses slowly gained his trust, allowed him the time to express his concerns and discuss his preferences, and helped him develop strategies to incorporate his desired lifestyle changes and wishes into his health regimen. The nurses filled a dose administration container for him each week and helped him to organise his prescriptions to ensure a continuous supply of antiretrovirals and other medicines. He was incapable of doing this himself effectively initially due to memory loss and planning difficulties but gradually improved and gained independence with managing his medicines. At each visit, he discussed his wish to stop antiretroviral therapy and return to his complementary therapies.  The nurses liaised with his GP over side-effects he experienced on antiretroviral therapy and helped him tailor his medication times to suit his dietary preferences, lifestyle, and tolerances.  They persuaded him to remain on antiretroviral therapy without imposing home visits upon him.  They provided a supportive environment where he felt confident that his concerns were heard and taken seriously.

Over time, Bert has stopped antiretroviral therapy on a few occasions for brief periods, when he felt that side-effects affected his functioning.  He recently requested a change in antiretroviral therapy due to joint pain, and this change has been successful.  Bert still has reservations about antiretroviral therapy but is adherent to it and remains well.  He lives a healthy lifestyle, eats well, exercises and meditates.  He maintains a strong relationship with his GP and the community nurses have discharged him from their service.  He occasionally calls with questions or concerns.