Adherence Strategies in Antiretroviral Therapy for HIV

Optimising adherence to antiretroviral therapy (ART) is fundamental to sustaining virological suppression, preventing drug resistance and reducing onward transmission. Strategies to support adherence span individual, interpersonal and structural levels. At the individual level, interventions include educational counselling, motivational interviewing and strategies to bolster self-efficacy. Technological tools such as electronic reminder systems, digital pillboxes and mobile health applications have been developed to prompt timely dosing and to record adherence patterns. At the interpersonal level, peer support groups, family-centred approaches and community health worker engagement foster a supportive environment for people living with HIV. Structurally, differentiated service delivery models adapt appointment schedules and medication refills to patient needs, while task-shifting to community health centres and pharmacy refill programmes decentralise care and reduce travel barriers. Long-acting injectable regimens and simplified dosing schedules further reduce pill burden and may enhance persistence. Behavioural theories underpin many interventions, guiding the design of multifaceted programmes that address cognitive, motivational and environmental determinants of adherence. Taken together, these strategies form an integrated framework that acknowledges the complexity of adherence and the need for tailored, context-sensitive solutions.

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Adherence Strategies in Antiretroviral Therapy for HIV publication trend

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Technical terms

Antiretroviral therapy (ART): Combination drug regimens that suppress HIV replication and maintain immune function.

Virological suppression: Reduction of plasma HIV RNA to undetectable levels, indicating effective ART.

Adherence self-efficacy: An individual’s confidence in their ability to follow prescribed medication regimens.

Patient-reported outcomes (PROs): Health status information provided directly by patients, reflecting symptoms, side effects and quality of life.

Syndemic: Co-occurring and interacting epidemics (for example, mental health disorders, substance use and HIV stigma) that exacerbate negative health outcomes.

References

1. Patient-Reported Barriers to Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis. PLOS Medicine (2016).
2. Utility and Impact of the Implementation of Same-Day, Self-administered Electronic Patient-Reported Outcomes Assessments in Routine HIV Care in two North American Clinics. AIDS and Behavior (2022).
3. A Qualitative Study to Identify Perceptual Barriers to Antiretroviral Therapy (ART) Uptake and Adherence in HIV Positive People from UK Black African and Caribbean Communities. AIDS and Behavior (2019).
4. A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS?. BMC Public Health (2007).
5. Task shifting of HIV/AIDS case management to Community Health Service Centers in urban China: a qualitative policy analysis. BMC Health Services Research (2015).