Materials and Links
|
Background:
With the development of HAART in 1996, HIV-related morbidity and mortality decreased dramatically in countries where the drugs are available. However, because HIV is able to develop resistance to all these drugs if not taken properly , the impact of adherence to drug therapies became a growing concern for people with HIV disease and HIV researchers and clinicians.
HAART is highly effective, but the drugs have short half-lives and are highly selective, favoring drug-resistant strains if therapeutic levels are not maintained. The drugs, however, often have difficult-to-follow dosing schedules and requirements, as well as multiple toxicities. It is important for patients and health care and social service providers to understand the need for and difficulties of adherence to treatment when they decide to initiate treatment and to maintain adherence over time.
Defining a Research Agenda
When treatment adherence first emerged as critical HIV treatment issue, the Forum conducted a thorough literature review on adherence research in other disease areas to determine what might be applicable to further understanding of HIV-related adherence. medical In addition, the Forum , co-sponsored the "Adherence to New HIV Therapies: A Research Conference," in November 1997 in conjunction with the NIH Office of AIDS Research (OAR) and the National Minority AIDS Council (NMAC). Conference participants developed an HIV treatment adherence research agenda. Issues addressed at the conference included:
- the current state of and need for good patient adherence to anti-viral therapies;
- research methods to measure and evaluate adherence;
- factors affecting adherence; and
- interventions to assist and enhance adherence.
Background information on medical non-adherence, proceedings from the conference, and recommendations for future research efforts were compiled into a post-conference report, "Adherence to New HIV Therapies: A Research Conference."
On November 11, 1998, David Barr, Director of the Forum, delivered a speech to over 2,000 conference participants at the 4th Conference on Drug Therapy in Glasgow, Scotland.
Examining HIV Adherence Initiatives
The Forum convened a second workshop in conjunction with the U. S. Health Services Resources Administration (HRSA) and the NIH OAR to review the development and impact of HIV-specific adherence initiatives in the two years following the original gathering. In preparation for the meeting, the Forum prepared a paper entitled Adherence to Highly Active Antiretroviral Therapy (HAART) Among Individuals with HIV/AIDS: A Compendium of HAART Adherence Research, November 1997–November 1999. The paper highlights relevant findings from an extensive review of peer-review journals and conference abstracts, including factors associated with adherence and non-adherence and adherence in specific populations. The workshop, which focused on interventions to assist patient efforts to adhere to therapy, resulted in the publication of Adherence to HIV Therapy: Building a Bridge to Success, which provides overviews of 20 different interventions to assist adherence to HIV therapies.
Treatment Simplification Strategies
Drug manufacturers and clinical researchers are working to develop less complex anti-viral treatment regimens in an effort to improve adherence. Simplifying Antiretroviral Treatment Regimens—a Summary of Current Research, provides an overview of recent research to simplify anti-viral treatment regimens. The article includes information about research related to the reduction in the number of doses per day and the number of drugs that patients need to take in order to effectively achieve maximum viral suppression.
