Memory Aides Unlikely to Improve Medication Adherence Among Many HIV Patients

Interventions to improve medication adherence tend to focus on short-term nonadherence and ignore sustained social issues.

Interventions to improve medication adherence tend to focus on short-term nonadherence and ignore sustained social issues.

For HIV-infected patients, adherence to antiretroviral therapy (ART) is critical, as compliance rates lower than 75% increase the risk of viral resistance by more than 150%. Although forgetfulness underlies occasional missed doses, social issues (eg, depression, stress, stigma, and poverty) drive long-term nonadherence.

Research published ahead-of-print in AIDS Care examined adherence strategies and barriers among patients with severe nonadherence (less than 75%) and uncovered that the causes of moderate and occasional nonadherence are more similar than those seen between moderate (75%-95%) and severe adherence.

The study’s computerized self-interview assessed active recreational drug use and HIV viral load in 556 infected patients who were less than 95% adherent to ART. The researchers followed up with unannounced pill counts to monitor adherence and any barriers to it.

Structural factors and substance abuse had the largest impact on severe nonadherence. A considerable number of alcohol and substance abusers expressed hesitance to mix their HIV regimen with alcohol or illicit drugs.

Poverty, lack of transportation, hunger, and homelessness were also significant adherence barriers. Patients with severe nonadherence reported depression, overwhelming feelings, and beliefs that their medications make them feel sick more often.

Cognitive challenges (eg, memory loss) were similar between moderate and severe nonadherent patients. Less-adherent patients reported using a greater number of memory aides to no avail. In many cases, the problem wasn’t intentional nonadherence, but more likely a lack of medication.

Memory aides are unlikely to help when patients miss more than 25% of doses. Consequently, adding more memory aids has a low chance to improve severe nonadherence.

When HIV-infected patients are severely nonadherent, clinicians need to provide serious interventions. These include substance use treatment and case management to resolve structural barriers. Providers should screen for substance abuse, mental illness, and social factors when severe nonadherence is a problem.