HIV Treatment Strategy

NOTE: additional Literature Review

 

Indeed, literature studies pertaining to HAART adherence behaviors of African American involves certain degree of useful and imperative factors such as culture, education and motivation incurring the situation that affected the population as being known, the various support studies determined in such medicine related journals and articles served crucial points for the study as integrated to provide an overview of experiences of HIV-infected patients and the processes underlying the factors identified in literature as organized in below points. In general, some background variables such as educational levels and age were found to be significant variables affecting treatment adherence, in addition to some religious support variables. The imperative sense have to be the interventions needed by the African American in order to help them recover from low literacy adherence related to HAART behavior.

 

(a) Culture, Religion, and Ethnicity

Using data from the second follow-up of the HIV Cost and Services Utilization Study, there investigated the influence of culture and religious support from treatment adherence for the African American as HIV patients. The study outcomes does show differential effects of social, religious support and background variables on treatment adherence. On the other hand, for African Americans as well as the Hispanics, religious and ethnic support variables were influential (1). Results then, suggest that strategies to improve treatment adherence may vary for different race/ethnic groups. There maybe importance of working with and involving religious organizations in an effort to increase adherence and support to HIV-infected members, particularly among African Americans and Hispanic communities. (2)

 

 

(b) Literacy skills and educational level

Thus, information appropriate to a patient’s level of understanding will lead to the patient having correct knowledge of what constitutes good adherence practice. Because a patient’s personal interpretation of good adherence practice may be based on misconceptions that are used to justify risky behaviour, it is important to ask patients to describe their behaviour and if necessary to repeat instructions that need attention in order to improve adherence. Attention should be given to literacy skills and education such as the capacity to organize better career life and one’s activities and the ability to anticipate risk situations. (1)

Furthermore, there involves health literacy relevance within the adherence to treatment for HIV and AIDS. The study presented multiple logistic regression showed that education and health literacy were significant and independent predictors of two days treatment adherence after controlling for age, ethnicity, income, HIV symptoms, substance abuse, social support, emotional distress, and attitudes toward primary care providers. Persons of low literacy were more likely to miss treatment doses because of confusion, depression, and desire to cleanse their body than were participants with higher health literacy. (3)

(c) Patient-Provider Relationship

In addition, there were four studies completed from the year 2005 up to the present that have highlighted the importance of the relationship between the provider and the patient in enhancing adherence behavior. The literature does extend certain work by comparing adherent and nonadherent clients in one high-volume HIV clinic in which the majority of care is provided by nursing staff. (5)

The indicator of the patient-provider relationship was satisfaction with the care provider as measured within the Patient Satisfaction Questionnaire. Client groups differed significantly on perception of interpersonal manner of care provider (p = .018), care provider conduct total (p < .001), and quality total (p = .017). These findings are consistent with earlier work and underscore the potential importance of the patient-provider relationship as a focus of care for nurses. (5)

The problem of inadequate adherence to prescribed highly active antiretroviral therapy (HAART) drug regimens to treat HIV infection and AIDS can be too ubiquitous. Adherence can be inadequate despite both provider and patient understanding of the consequences of nonadherence. Successful long-term treatment of HIV/AIDS requires at least 95 percent adherence to HAART in order to prevent emergence of drug-resistant HIV variants that lead to regimen failure and limit options for future therapy. Despite the prevalence of inadequate adherence, many patients succeed and HAART has transformed HIV infection into a chronic illness increasingly managed in primary care. The barriers to adherence observed in HIV treatment resemble barriers to the successful treatment of some chronic diseases resulting in patient-provider relationships. (4) Treatment of HIV infection shown patient provider collaboration can result in the selection of lifestyle-tailored regimen characterized by convenient dosing, low pill burden and tolerable side effects that enhances adherence, effectiveness and the patient’s willingness to remain on anti-HIV therapy long term. Literature studies in review focuses on the current understanding of adherence reporting, improvement of adherence, and, hence, improvement of treatment outcomes in HIV infection and AIDS. (3)

 

(d) Motivational Interventions

There was one study which sought to uncover the prevalence of continued drug use and statements about everyday adherence decision-making from community sample of HIVseropositive individuals with history of substance use. Ninety participants attended one of three focus groups and, collectively, generated 100 statements describing their day-to-day motivations and barriers to HIV-medical adherence. In addition, participants’ self-reported substance use revealed that just under 40% (n = 33) were juggling substance use and their HIV medication regimens within the past 30 days. (2,3)

The statements reveal varied and complex adherence factors, which included relatively more non-drug-related than drug-related factors. Furthermore, some respondents non-drug-related statements covered broad range of reasons related to adherence that tended to fall into the same major categories as those found across motivation system from within individual factors. The authors discuss the need for providers to consider the breath and complexity of adherence factors that impact readiness to initiate and adhere to HAART behaviors for the African American population. (4)

 

(e) Socioeconomic factors

In addition, acquiring insight into patient’s social support systems and counseling on how to use them is a valuable strategy in optimizing adherence. Social support has to be substantial and practical, such as reminders to take medication. Attention should also be paid to possible negative influences on adherence in the patient’s environment, perhaps coordinating the schedules of partners or dealing with discouraging influence as for instance, African mothers of young children may need help to fit the medication into the family’s hectic schedule. HAART’s potential for long-term effectiveness is dependent upon maximum and durable suppression of socio economic  stance from within societal representations. There has been logistic regression analysis was conducted to determine associations of sociodemographic and psychosocial variables with adherence to antiretroviral regimen. Results indicated that heterosexual participants and participants of Latino ethnicity are significantly more likely to report missed medications. Perceived satisfaction with support from a partner was associated with taking antiretroviral therapy as prescribed, whereas satisfaction with support from friends and from family was not significantly related to adherence. (4)

 

(f) Social Support

The relationship of adherence to antiretroviral treatment with types of social support such as partner, friends, and family as one study indicated that, from the inclusion criteria, parent trial participants taking antiretroviral therapies, and those with complete data on self-reported measures of adherence were considered eligible for the present study. Overall, 26 percent of participants were found to be nonadherent, which was defined as one or more missed doses of treatment in the prior 4-day period. Examination of coping strategies showed that participants reporting drug and alcohol use to cope with HIV-related stress were more likely to be nonadherent. (5) These findings call for adherence interventions designed to address barriers and strengths, such as community norms and or traditional cultural values, specific to certain populations. Furthermore, couple based approaches enlisting partner support may help persons living with HIV to adhere to antiretroviral regimens. There is also trusting relationship with the healthcare provider is essential. This relationship is built on support and open communication. Providers should give clear instructions on how to take medication, explain the relationship between adherence and viral load and offer good medical follow-up. Supplementing the adherence support efforts by physicians, nurses, and pharmacists, clinicians in a range of disciplines and settings can assess and intervene on psychosocial risk factors and thereby reduce adherence problems regardless of their level of knowledge about HIV medication and for this review, those with higher levels of social support from partners demonstrated higher rates of medication adherence. Those who received more social support from their families, reported significantly lower adherence rates as there suggest that efforts to improve medication adherence need to address the diverse types of social support networks of people diagnosed with HIV/AIDS. (5)

 

(g) Drug use

High levels of medication adherence are crucial to the success of HIV treatment. Consequently, substance abuse counselors (SACs), social service and other care providers can best support their HIV positive clients when they understand adherence and related interventions. This paper describes a training program that was designed to increase counselor knowledge of HIV medications, adherence strategies and enhance counseling skills specific to HIV adherence. For substance abuse counselors the training needs included: better understanding of medication interactions, relapse, recovery, and interdisciplinary communication. Thirty-six SACsfrom three agencies completed the 1 1/2-day training, which included lecture discussions, case discussion and interactive client case simulations. Success in accomplishing training objectives was evaluated at three points: pre-intervention training, post-intervention as well as six month follow-up to determine changes in participants’ knowledge, attitudes and behaviors related to adherence counseling. Three case scenarios measuring counselor comfort levels indicated SACs felt significantly more comfortable discussing relapse and medication issues with their HIV affected clients than they would in discussing medication issues with the client’s physician. However, they felt slightly more comfortable about physician discussions after training. Open-ended comments by SACs at six-month follow-up provided insights into recovery issues their clients faced. The findings suggest ways medication adherence could fit the reality of serving clients with co-occurring HIV and substance use to better meet their health and support needs. (6)

 

It has also been hypothesized that HIV-positive individuals who have a history of using drugs, may be less adherent to AR therapy than those without this behavior or history. In a large sample of 727 individuals, 56.8% reporting never using injection drugs and 39.3% reporting being a former or current user, injecting drug use was not related to keeping appointments or following healthcare advice and instruction. Having certain positive attitude toward the future, a good relationship with one’s medical team, belief that ARs improve survival and help compliance with heroin free state, and being in prison were factors positively affecting continuance of therapy. Though race overall may not be an indicator, there may be characteristics or confounding factors within different racial groups that affect levels of adherence. For example, in a cross-sectional study of 158 outpatient HIV clinic patients, African Americans were no less likely to adhere to ARs than Caucasians (race OR=1.06). Caucasians reported inconvenience of medications (p=0.02) and taking more medication as directed as barriers to adherence; whereas, African-Americans reported that no storage place for medications (p=0.024), ceasing medication use because of feeling better (p=0.033), not taking medication away from home (p=0.014), and being to embarrassed to get refills (p=0.019) (7) were barriers.90 In a study of 74 HIV-infected patients that investigated the association of literacy with AR adherence regimens among African-Americans and Caucasians. African-Americans were found to be significantly less adherent to ARs (31% vs. 11%, p<.05), understood less the meaning of CD4 lymphocyte counts (56.3% vs. 77.1%, p<0.0001), and were less likely to understand the meaning of HIV-viral load measurement (87.5% vs. 28.6%, p<0.0001). Over three-quarters (83.3%) of Caucasian patients were always adherent to ARs compared to 66.7% of African-Americans with high literacy; only 34.1% of African-Americans with less than a 6th grade reading level adhered to ARs (p<0.0001). Thus, for one, in substance use, it is important to find a way to minimize the risk that substance use will remain the first priority in life. Professional support or daily observed therapy can be an option. (7)

 

Aside, quality adherence to behavior therapy is an ongoing process in which the patient needs to be directly involved, it is not something an individual naturally possesses or lacks. Interventions to increase adherence must address cultural differences within race, gender, sexual orientation, and even religion. They must be tailored to meet culturally relevant barriers, including differences in language. Efforts must continue that help patients complete treatment, paying close attention to socio-cultural circumstances as well as the psychological and economic factors that may impede upon adherence. Physicians should not automatically assume a future of poor adherence by their patients on the basis of demographic and behavioral characteristics. These assumptions, on the part of the clinician, could stigmatize the clinician-patient relationship, thereby possibly introducing an additional impediment to adherence. An emphasis on language that stresses the inability of the patient to adhere to the devised medication regimen should be dropped and supplemented with language that stresses the role of the patient in devising and implementing an individualized treatment plan. Such language should be as elementary as possible with no reference to medical jargon.. Further study of the factors in HAART adherence is needed. Evaluations of adherence intervention tools, including counseling programs, DOT, methods to assist patients in deciding whether to start antiretroviral therapy, and educational materials are also needed. The success or failure of HAART, both as a treatment strategy for patients and a public health strategy to prevent the spread of multi-drug resistant HIV, is dependent upon the ability of patients to adhere to therapy. Support to assist patients in their adherence efforts should be comprehensive and considered a high priority in the delivery of HIV primary care and social services.

 

 

 

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