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AIDS Clin Care. 1997 Jul;9(7):51-4, 58.

Adherence, compliance, and HAART.

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Yale / New Haven Hospital, AIDS Care Program, New Haven, CT.



The development and use of new, highly active antiretroviral therapy (HAART) requires a discussion of a factor that is key to the success of these regimens, i.e., patient adherence. The term compliance is more often used, but adherence is the preferred term and considered more accurate because it implies and recognizes patient choice in therapy. To gain a durable suppression of viral replication, near-perfect adherence to dosage, timing, frequency, and food requirements is necessary. Primary care physicians must be skilled in helping patients adhere to their regimens. Factors determining patient adherence include the following: 1) patient characteristics, 2) clinician characteristics, 3) clinician-patient relationship, 4) characteristic of the illness, and 5) characteristics of the regimen. Various methods of determining adherence include patient self-reports, pill counts, review of pharmacy records, drug assays, and determination of surrogate markers. The medication-event monitoring system records frequency and time of opening pill bottles. Patient-focused strategies, such as education and involvement in treatment decision making, must be developed to support and improve adherence; behavior therapy may also be useful. Clinicians must also utilize continuing education to learn to assist their patients. When possible, regimens should be simplified as much as possible, and clinicians must maintain a good relationship with their patients.

[Indexed for MEDLINE]

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