| Chapter 2: | Treating HIV/AIDS |
|
|
community’s efforts to control HIV (Munro,Lewin, Swart, & Volmink, 2007; Redding,Rossi, Rossi, Velicer, & Prochaska, 2000).
Defining HAART and Medication Adherence
Before discussing public health implications of adherence failure and influential adherence factors, it is necessary to define medication and HAART adherence and understand its importance. HAART adherence in this study refers to medication adherence as well as following health providers’ lifestyle recommendations that are crucial to the control of HIV infection. These recommendations include the execution of lifestyle changes such as maintaining good nutrition, refraining from alcohol, and engagement in safe sex practices; the last strategy is known as ABC, where A stands for abstinence until marriage, B for being faithful to one sex partner, and C for using a condom regularly if all of the previous are not possible (FAO, 2002; Schmitt & Mehta, 2002; WHO, 2003a; WHO, 2009a). In contrast, there is no standardized definition of medication adherence. However, researchers often refer to medication adherence as the extent to which patients take medication exactly as prescribed by health care providers in terms of dosing, frequency, and timing—a definition adopted in this study (Machtinger & Bangsberg, 2008; Park & Mayhorn, 1996; Weinberg & Friedland, 1998).
Medication Adherence Among Chronically Ill Patients
Researchers agree that effective treatment of HIV requires about 95% or higher medication adherence, which is especially difficult to achieve when treatment is long-term, as is the case for HIV, currently considered a chronic illness (Garcia & Cote, 2003; Hammer et al., 2006; Mannheimer, Friedland, Matts, Child, & Chesney, 2002). Research is unclear about how to measure 95% adherence. However, Machtinger and Bangsberg (2008) indicated that 95% adherence is attainable by not missing fewer than three doses in a month. Unfortunately, although adherence studies remain scarce, a few scholars have revealed that suboptimal adherence to HAART is common in all groups of treated individuals (Machtinger & Bangsberg, 2008; Munro et al., 2007). In Harrigan et al.’s