Sticking to your HIV medication schedule -- a.k.a. adherence -- is crucial to fight the virus and prevent drug resistance. But "take as directed" isn't always as straightforward as it sounds. Side effects, drug interactions, depression, an irregular routine and "treatment fatigue" can all throw up roadblocks. A few innovative programs offer people living with HIV support and strategies to overcome barriers and stay on course.
Starting HIV treatment can be a difficult decision to make; staying on it for years and doing so without support can be even harder. In Montreal, people with HIV who are interested in exploring their treatment options or discussing adherence challenges one-on-one need look no further than AIDS Community Care Montreal (ACCM)'s treatment information facilitator, Sylvain Beaudry. Members can call or visit him to discuss any issues they may be experiencing.
Starting in fall 2013, ACCM will offer the innovative My Life with HIV workshop series, which will focus on antiretrovirals -- how to incorporate them into your life, manage side effects and stay adherent. The agency also ensures that clients have the most up-to-date information by inviting pharmacologists and other healthcare professionals to highlight new meds and discuss those currently available.
If you're after a way to stay adherent or have questions about your treatment, ACCM's staff is ready to support you.
Windsor Regional Hospital
One of the most comprehensive adherence support programs in Ontario is the HIV Care Program at Windsor Regional Hospital. This outpatient clinic is run by a group of devoted service providers that includes two pharmacists, physicians, nurses, a psychologist and a dietitian.
Every person who comes to the clinic becomes part of a community of care that emphasizes an attentive and holistic approach to improving adherence. This includes one-on-one counselling, the use of dosette boxes and scheduled medication pickups. A link with the pharmacy gives this clinic its edge -- records of when each person is due for a refill help staff track how often prescriptions are being renewed. This can prompt discussion about how patients can be further supported to take their meds.
In recent years, the need for adherence support has expanded, as many long-term survivors are also taking meds for other conditions, such as high cholesterol, depression and osteoporosis. With HIV meds comprising just some of the many pills they must take in a day, this program has become integral to the continued support of people living with HIV.
With a strong focus on treatment programs tailored to each individual, the Northern Alberta HIV Program is a shining example of how excellent adherence supports can make a difference in people's lives. Working to build strong connections with the people it serves has been the model of success for this clinic, which provides care to people living with or affected by HIV across northern Alberta and the Northwest Territories.
The staff includes a psychologist, social workers, pharmacists and other healthcare providers who place their relationships with patients at the forefront of care. Appointments can last more than an hour and the pharmacist is careful to customize HIV treatment to each individual's life. This involves getting to know a person's work schedule and living situation as well as any confidentiality issues they may be dealing with related to their meds. Understanding the context of a person's treatment in this way makes it easier to pinpoint any barriers to adherence and to find strategies that help people stick with their treatment.
After seeing more and more pregnant women access its services, the program has increased its focus on this group. Clinical pharmacist Michelle Foisy and her team have started a comprehensive treatment support plan that is both collaborative and customized to the needs of pregnant women and new moms. Since its inception, the clinic has seen excellent results, with a transmission rate of less than one percent in the perinatal program (one out of 111 infants was born HIV positive).
At the crack of dawn, 365 days a year, the doors of the Downtown Community Health Clinic open to offer breakfast to people in the Downtown Eastside. This tiny but busy space in a community where many lack stable housing provides a chance to get out of the rain, enjoy a cup of coffee and access health supports. Some people come for an appointment at the clinic, while others drop in for their daily dose of HIV medication. The clinic has had great success helping its members stay on their meds and the addition of the Maximally Assisted Therapy (MAT) Program has contributed hugely to that success.
The MAT team of nurses, community workers, social worker and pharmacist offers a wide range of adherence supports. Members are encouraged to use services that range from counselling and regular checkups for blood work to appointments with the nutritionist or infectious disease doctor. Additionally, outreach teams travel throughout the city to distribute medication to members regardless of where they are, ensuring that adherence isn't affected by lack of bus fare, having no fixed address, depression or drug use. MAT outreach workers have brought treatment to some of the most hard-to-reach people in Vancouver.
Evaluation of the program has shown that nine out of every 10 MAT clients now have a suppressed viral load and adherence rates appear to be high. The program is also beginning to see evidence of lowered transmission rates.
For a comprehensive guide to preparing for HIV treatment, choosing the right combination and adhering to your medication schedule, see CATIE's Practical Guide to HIV Drug Treatment. You can also order print copies through the CATIE Ordering Centre. The guide is free for people in Canada.