As well as monitoring retention, the guidelines call for monitoring of the entry process: “Within a given jurisdiction or service area, providers of testing services, local public health institutions, and medical clinics have a shared responsibility to monitor entry into HIV care.”
Specifically, they suggest that a case-management approach, as opposed to a simple referral, is the way to go.
The number of people living with HIV rose from around 8 million in 1990 to 34 million by the end of 2010. The overall growth of the epidemic has stabilised in recent years. The annual number of new HIV infections has steadily declined and due to the significant increase in people receiving antiretroviral therapy, the number of AIDS-related deaths has also declined.
Since the beginning of the epidemic, nearly 30 million people have died from AIDS-related causes.
UNAIDS (2010) ‘Unite for universal access: Overview brochure on 2011 High Level Meeting on AIDS’
When it comes to adherence to medication, the guidelines again suggest a personal approach.
Caregivers should routinely ask about adherence, instead of waiting until there’s a reason to suspect nonadherence. And practical measures - such as pill organizers or pharmacy refill counts - also can help.
The accuracy of a patient’s self-reported adherence can be questioned. Thomson noted, but “often people don’t even ask.”
In every practice, there should be “some systematic way to talk about adherence with the patient,” she said. Among other things, just bringing the subject up routinely helps impress its importance on patients, she added.
The guidelines panel noted the recommendations in many cases would need additional resources to be fully implemented.
Primary source: Annals of Internal Medicine
Source reference: Thompson M, et al “Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an international association of physicians in AIDS care panel” Ann Int Med 2012.