Skip to main content
Log in

Strategies for promoting adherence to antiretroviral therapy: A review of the literature

  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

The success of antiretroviral therapy (ART) for HIV infection, though widespread and resounding, has been limited by inadequate adherence to its unforgiving regimens, especially over the long term. This article summarizes the literature on behavioral interventions to promote ART adherence and highlights some of the most recent and innovative research on patient education and case management, modified directly observed therapy, contingency management, interventions emphasizing social support, and novel technologies to promote awareness. Research in the area of adherence in pediatric HIV infection and in resource-constrained international settings also is considered. Although adherence interventions have been successful in experimental trials, they may not be feasible or adaptable given the constraints of real-world clinics and community-based settings. Implementation and dissemination of adherence interventions needs increased attention as ART adherence research moves beyond its first decade. We conclude with suggestions for incorporating research findings into clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Jones J, Taylor B, Wilkin TJ, Hammer S: Advances in antiretroviral therapy. Top HIV Med 2007, 15:48–82.

    PubMed  Google Scholar 

  2. Crum NF, Riffenburgh RH, Wegner S, et al.: Comparisons of causes of death and mortality rates among HIV-infected persons: analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. J Acquir Immune Defic Syndr 2006, 41:194–200.

    Article  PubMed  Google Scholar 

  3. Shuter J: Forgiveness of non-adherence to HIV-1 antiretroviral therapy. J Antimicrob Chemother 2008, 61:769–773.

    Article  PubMed  CAS  Google Scholar 

  4. Giacca M: Gene therapy to induce cellular resistance to HIV-1 infection: lessons from clinical trials. Adv Pharmacol 2008, 56:297–325.

    Article  PubMed  CAS  Google Scholar 

  5. Perno CF, Moyle G, Tsoukas C, et al.: Overcoming resistance to existing therapies in HIV-infected patients: the role of new antiretroviral drugs. J Med Virol 2008, 80:565–576.

    Article  PubMed  CAS  Google Scholar 

  6. Ross L, Lim ML, Liao Q, et al.: Prevalence of antiretroviral drug resistance and resistance-associated mutations in antiretroviral therapy-naive HIV-infected individuals from 40 United States cities. HIV Clin Trials 2007, 8:1–8.

    Article  PubMed  Google Scholar 

  7. SPREAD programme: Transmission of drug-resistant HIV-1 in Europe remains limited to single classes. AIDS 2008, 22:625–635.

    Google Scholar 

  8. Curioso WH, Kurth AE, Blas MM, Klausner JD: Information and communication technologies for prevention and control of HIV infection and other STIs. In press.

  9. Nieuwkerk PT, Sprangers MA, Burger DM, et al.: Limited patient adherence to highly active antiretroviral therapy for HIV-1 infection in an observational cohort study. Arch Intern Med 2001, 161:1962–1968.

    Article  PubMed  CAS  Google Scholar 

  10. Wang H, He G, Li X, et al.: Self-reported adherence to antiretroviral treatment among HIV-infected people in central China. AIDS Patient Care STDS 2008, 22:71–80.

    Article  PubMed  CAS  Google Scholar 

  11. Mills EJ, Nachega JB, Bangsberg DR, et al.: Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med 2006, 3:e438.

    Article  PubMed  Google Scholar 

  12. Bangsberg DR, Ware N, Simoni JM: Adherence without access to antiretroviral therapy in sub-Saharan Africa? AIDS 2006, 20:140–141; author reply 141–142.

    PubMed  Google Scholar 

  13. Haynes RB, Taylor DW, Sackett DL: Compliance in Health Care. Baltimore, MD: Johns Hopkins University Press; 1979.

    Google Scholar 

  14. Bangsberg DR, Kroetz DL, Deeks SG: Adherence-resistance relationships to combination HIV antiretroviral therapy. Curr HIV/AIDS Rep 2007, 4:65–72.

    Article  PubMed  Google Scholar 

  15. Gardner EM, Sharma S, Peng G, et al.: Differential adherence to combination antiretroviral therapy is associated with virological failure with resistance. AIDS 2008, 22:75–82.

    PubMed  CAS  Google Scholar 

  16. Maggiolo F, Airoldi M, Kleinloog HD, et al.: Effect of adherence to HAART on virologic outcome and on the selection of resistance-conferring mutations in NNRTI-or PI-treated patients. HIV Clin Trials 2007, 8:282–292.

    Article  PubMed  Google Scholar 

  17. Pearson CR, Simoni JM, Hoff P, et al.: Assessing antiretroviral adherence via electronic drug monitoring and self-report: An examination of key methodological issues. AIDS Behav 2007, 11:161–173.

    Article  PubMed  Google Scholar 

  18. Simoni JM, Kurth AE, Pearson CR, et al.: Self-report measures of antiretroviral therapy adherence: a review with recommendations for HIV research and clinical management. AIDS Behav 2006, 10:227–245.

    Article  PubMed  Google Scholar 

  19. Mannheimer S, Thackeray L, Hullsiek KH, et al.: A randomized comparison of two instruments for measuring self-reported antiretroviral adherence. AIDS Care 2008, 20:161–169.

    Article  PubMed  CAS  Google Scholar 

  20. Mills EJ, Nachega JB, Bangsberg DR, et al.: Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med 2006, 3:e438.

    Article  PubMed  Google Scholar 

  21. Fisher JD, Fisher WA, Amico KR, Harman JJ: An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol 2006, 25:462–473.

    Article  PubMed  Google Scholar 

  22. Reynolds NR, Sanzero Eller L, Nicholas PK, et al.: HIV illness representation as a predictor of self-care management and health outcomes: a multi-site, cross-cultural study. AIDS Behav 2007 (Epub ahead of print).

  23. Remien RH, Stirratt MJ, Dognin J, et al.: Moving from theory to research to practice. Implementing an effective dyadic intervention to improve antiretroviral adherence for clinic patients. J Acquir Immune Defic Syndr 2006, 43(Suppl 1):S69–S78.

    PubMed  Google Scholar 

  24. Simoni JM, Amico RK, Pearson CR, Malow RM: Overview of adherence to antiretroviral therapies. In HIV/AIDS: Global Frontiers in Prevention/Intervention. Edited by Pope C, White R, Malow R. New York: Taylor & Francis; 2008.

    Google Scholar 

  25. Wrubel J, Moskowitz JT, Richards TA, et al.: Pediatric adherence: perspectives of mothers of children with HIV. Soc Sci Med 2005, 61:2423–2433.

    Article  PubMed  Google Scholar 

  26. Fogarty L, Roter D, Larson S, et al.: Patient adherence to HIV medication regimens: a review of published and abstract reports. Patient Educ Couns 2002, 46:93–108.

    Article  PubMed  Google Scholar 

  27. Haddad M, Inch C, Glazier RH, et al.: Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS. Cochrane Database Syst Rev 2000, 3:CD001442.

    PubMed  Google Scholar 

  28. Amico KR, Harman JJ, Johnson BT: Efficacy of antiretroviral therapy adherence interventions: a research synthesis of trials, 1996 to 2004. J Acquir Immune Defic Syndr 2006, 41:285–297.

    Article  PubMed  Google Scholar 

  29. Simoni JM, Pearson CR, Pantalone DW, et al.: Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load. A metaanalytic review of randomized controlled trials. J Acquir Immune Defic Syndr 2006, 43(Suppl 1):S23–S35.

    PubMed  Google Scholar 

  30. Rollnick S, Mason P, Butler C: Health Behavior Change: A Guide for Practitioners. London: Churchill Livingstone; 1999.

    Google Scholar 

  31. Wagner GJ, Kanouse DE, Golinelli D, et al.: Cognitive-behavioral intervention to enhance adherence to antiretroviral therapy: a randomized controlled trial (CCTG 578). AIDS 2006, 20:1295–1302.

    Article  PubMed  Google Scholar 

  32. Carrico AW, Antoni MH, Duran RE, et al.: Reductions in depressed mood and denial coping during cognitive behavioral stress management with HIV-positive gay men treated with HAART. Ann Behav Med 2006, 31:155–164.

    Article  PubMed  Google Scholar 

  33. Safren SA, Otto MW, Worth J: LifeSteps: applying cognitive behavioral therapy to patient adherence to HIV medication treatment. Cogn Behav Pract 1999, 6:332–341.

    Article  Google Scholar 

  34. Chiou PY, Kuo BI, Lee MB, et al.: A programme of symptom management for improving quality of life and drug adherence in AIDS/HIV patients. J Adv Nurs 2006, 55:169–179.

    Article  PubMed  Google Scholar 

  35. Mitchell CG, Linsk NL: A multidimensional conceptual framework for understanding HIV/AIDS as a chronic longterm illness. Social Work 2004, 49:469–476.

    PubMed  Google Scholar 

  36. Rueda S, Park-Wyllie LY, Bayoumi AM, et al.: Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS. Cochrane Database Syst Rev 2006, 3:CD001442.

    PubMed  CAS  Google Scholar 

  37. Smith-Rohrberg D, Mezger J, Walton M, et al.: Impact of enhanced services on virologic outcomes in a directly administered antiretroviral therapy trial for HIV-infected drug users. J Acquir Immune Defic Syndr 2006, 43(Suppl 1):S48–S53.

    PubMed  Google Scholar 

  38. Williams AB, Fennie KP, Bova CA, et al.: Home visits to improve adherence to highly active antiretroviral therapy: a randomized controlled trial. J Acquir Immune Defic Syndr 2006, 42:314–321.

    Article  PubMed  Google Scholar 

  39. Altice FL, Maru DS, Bruce RD, et al.: Superiority of directly administered antiretroviral therapy over self-administered therapy among HIV-infected drug users: a prospective, randomized, controlled trial. Clin Infect Dis 2007, 45:770–778.

    Article  PubMed  CAS  Google Scholar 

  40. Tyndall MW, McNally M, Lai C, et al.: Directly observed therapy programmes for anti-retroviral treatment amongst injection drug users in Vancouver: access, adherence and outcomes. Int J Drug Policy 2007, 18:281–287.

    Article  PubMed  Google Scholar 

  41. Behforouz HL, Farmer PE, Mukherjee JS: From directly observed therapy to accompagnateurs: enhancing AIDS treatment outcomes in Haiti and in Boston. Clin Infect Dis 2004, 38(Suppl 5):S429–S436.

    Article  PubMed  Google Scholar 

  42. Pearson CR, Micek MA, Simoni JM, et al.: Randomized control trial of peer-delivered, modified directly observed therapy for HAART in Mozambique. J Acquir Immune Defic Syndr 2007, 46:238–244.

    Article  PubMed  CAS  Google Scholar 

  43. Myung P, Pugatch D, Brady MF, et al.: Directly observed highly active antiretroviral therapy for HIV-infected children in Cambodia. Am J Public Health 2007, 97:974–977.

    Article  PubMed  Google Scholar 

  44. Mitty JA, Huang D, Loewenthal HG, et al.: Modified directly observed therapy: sustained self-reported adherence and HIV health status. AIDS Patient Care STDS 2007, 21:897–899.

    Article  PubMed  Google Scholar 

  45. Ciambrone D, Loewenthal HG, Bazerman LB, et al.: Adherence among women with HIV infection in Puerto Rico: the potential use of modified directly observed therapy (MDOT) among pregnant and postpartum women. Women Health 2006, 44:61–77.

    PubMed  Google Scholar 

  46. Garland WH, Wohl AR, Valencia R, et al.: The acceptability of a directly-administered antiretroviral therapy (DAART) intervention among patients in public HIV clinics in Los Angeles, California. AIDS Care 2007, 19:159–167.

    Article  PubMed  CAS  Google Scholar 

  47. Goggin K, Liston RJ, Mitty JA: Modified directly observed therapy for antiretroviral therapy: a primer from the field. Public Health Rep 2007, 122:472–481.

    PubMed  Google Scholar 

  48. Pearson CR, Micek M, Simoni JM, et al.: Modified directly observed therapy to facilitate highly active antiretroviral therapy adherence in Beira, Mozambique. Development and implementation. J Acquir Immune Defic Syndr 2006, 43(Suppl 1):S134–S141.

    PubMed  Google Scholar 

  49. Macalino GE, Hogan JW, Mitty JA, et al.: A randomized clinical trial of community-based directly observed therapy as an adherence intervention for HAART among substance users. AIDS 2007, 21:1473–1477.

    Article  PubMed  Google Scholar 

  50. Haug NA, Sorensen JL: Contingency management interventions for HIV-related behaviors. Curr HIV/AIDS Rep 2006, 3:154–159.

    Article  PubMed  Google Scholar 

  51. Javanbakht M, Prosser P, Grimes T, et al.: Efficacy of an individualized adherence support program with contingent reinforcement among nonadherent HIV-positive patients: results from a randomized trial. J Int Assoc Physicians AIDS Care (Chic Ill) 2006, 5:143–150.

    Article  Google Scholar 

  52. Rosen S, Ketlhapile M, Sanne I, DeSilva MB: Cost to patients of obtaining treatment for HIV/AIDS in South Africa. S Afr Med J 2007, 97:524–529.

    PubMed  Google Scholar 

  53. Sorensen JL, Haug NA, Delucchi KL, et al.: Voucher reinforcement improves medication adherence in HIV-positive methadone patients: a randomized trial. Drug Alcohol Depend 2007, 88:54–63.

    Article  PubMed  Google Scholar 

  54. Remien RH, Stirratt MJ, Dognin J, et al.: Moving from theory to research to practice. Implementing an effective dyadic intervention to improve antiretroviral adherence for clinic patients. J Acquir Immune Defic Syndr 2006, 43(Suppl 1):S69–S78.

    PubMed  Google Scholar 

  55. Simoni JM, Pantalone DW, Plummer MD, Huang B: A randomized controlled trial of a peer support intervention targeting antiretroviral medication adherence and depressive symptomatology in HIV-positive men and women. Health Psychol 2007, 26:488–495.

    Article  PubMed  Google Scholar 

  56. Curioso WH, Blas MM, Nodell B, et al.: Opportunities for providing web-based interventions to prevent sexually transmitted infections in Peru. PLoS Med 2007, 4:e11.

    Article  PubMed  Google Scholar 

  57. Fisher JD, Amico KR, Shuper PA: Intervention demonstration: a CD-ROM delivered program to improve adherence in HIV-infected clinic patients. Presented at NIMH/IAPAC International Conference on HIV Treatment Adherence. Jersey City, NJ; March 1, 2007.

  58. Andrade AS, McGruder HF, Wu AW, et al.: A programmable prompting device improves adherence to highly active antiretroviral therapy in HIV-infected subjects with memory impairment. Clin Infect Dis 2005, 41:875–882.

    Article  PubMed  Google Scholar 

  59. Simoni JM, Montgomery A, Martin E, et al.: Adherence to antiretroviral therapy for pediatric HIV infection: a qualitative systematic review with recommendations for research and clinical management. Pediatrics 2007, 119:e1371–e1383. http://pediatrics.aappublications.org/cgi/content/full/1119/1376/e1371.

    Article  PubMed  Google Scholar 

  60. Dodds S, Blakley T, Lizzotte JM, et al.: Retention, adherence, and compliance: special needs of HIV-infected adolescent girls and young women. J Adolesc Health 2003, 33(2 Suppl):39–45.

    Article  PubMed  Google Scholar 

  61. Ivers IC, Kendrick D, Doucette D: Efficacy of antiretroviral therapy programs in resource-poor settings: a meta-analysis of the published literature. Clin Infect Dis 2005, 41:217–224.

    Article  PubMed  CAS  Google Scholar 

  62. Mukherjee JS, Ivers L, Leandre F, et al.: Antiretroviral therapy in resource-poor settings. Decreasing barriers to access and promoting adherence. J Acquir Immune Defic Syndr 2006, 43(Suppl 1):S123–S126.

    PubMed  Google Scholar 

  63. Wong IY, Lawrence NV, Struthers H, et al.: Development and assessment of an innovative culturally sensitive educational videotape to improve adherence to highly active antiretroviral therapy in Soweto, South Africa. J Acquir Immune Defic Syndr 2006, 43(Suppl 1):S142–S148.

    PubMed  Google Scholar 

  64. Mills EJ, Cooper C: Simple, effective interventions are key to improving adherence in marginalized populations. Clin Infect Dis 2007, 45:916–917.

    Article  PubMed  Google Scholar 

  65. Panel on Clinical Practices for Treatment of HIV: Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents. Atlanta, GA: Centers for Diseases Control and Prevention; 2002.

    Google Scholar 

  66. Remien RH, Mellins CA: Long-term psychosocial challenges for people living with HIV: let’s not forget the individual in our global response to the pandemic. AIDS 2007, 21(Suppl 5):S55–S63.

    Article  PubMed  Google Scholar 

  67. Chesney MA: The elusive gold standard. Future perspectives for HIV adherence assessment and intervention. J Acquir Immune Defic Syndr 2006, 43(Suppl 1):S149–S155.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jane M. Simoni.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Simoni, J.M., Amico, K.R., Pearson, C.R. et al. Strategies for promoting adherence to antiretroviral therapy: A review of the literature. Curr Infect Dis Rep 10, 515–521 (2008). https://doi.org/10.1007/s11908-008-0083-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-008-0083-y

Keywords

Navigation