It is well known and understood by everyone who treats HIV
and by those who are taking medications for HIV that
excellent adherence to the medication regimen is required in
order for the medications to work and to prevent the virus
from becoming resistant to the medications that are
prescribed, as well as to other medications that may be
needed in the future. The development of drug resistance is
a very complicated issue. The bottom line is that many
well-executed clinical trials have proven that these
medications must be taken exactly as prescribed, following
instructions for taking them with or without food, at the
proper times and intervals. Adherence to these medications
needs to be at least 95%, which doesn’t leave much room for
error, complacency, or “forgetting”.

HIV treaters and the adherence counselors and nurses working
with them spend many hours educating patients and assessing
their adherence to medications. This issue is addressed
intensively when a patient starts medications, and on all
followup office visits. Most AIDS Service Organizations and
HIV providers have a formal Adherence Program, which
evaluates a patient’s knowledge of HIV and his or her
readiness to start medications and helps to identify any
potential barriers to their success in being able to take
the medications consistently. Drug and alcohol abuse and
mental illness issues need to be addressed at this point,
although in many cases patients with these issues are able
to take the medications as prescribed. Close one-on-one
counseling and support is provided, and the patient is
empowered to incorporate the medication regimen into his or
her daily life by examining daily routines and ways to be
reminded to take the medication as well as how to prepare
for unforeseen circumstances (such as working an extra shift
at work). Education itself is the best tool for adherence;
if patients know why medications are prescribed, believes
that they will benefit from them and be healthier, and
understands the implications of not taking them
consistently, they will be more likely to be adherent. In
addition to education, other tools to assist with adherence
are the involvement of family or friends to provide
reminders, charts with medication times to post in
conspicuous areas of the home, organization of pills into
weekly pillboxes, keeping an extra dose of medications at
work, in the car, or in a purse, and electronic medication
reminders.

So, what do we do when all of this fails, and a patient
keeps “forgetting” to take their medications? It’s back to
square-one. The first thing is to re-assess the person’s
understanding of the importance of taking the medications as
prescribed and the implications of missing doses. Next,
reassess what is going on in his or her life; unusual or new
stress, the breakup of a relationship, recent relapse or
increase in drug or alcohol use, and transportation problems
to get to the pharmacy are just a few of the many things
that could result in someone becoming careless with their
regimen. It might be that the patient needs to be referred
for substance abuse or short-term mental health counseling.

If the patient convinces us that he or she is committed to
taking the medications, but just keeps “forgetting” them, it
may be helpful to help the patient to identify a reliable
friend or family member who will be willing to commit to
making a reminder phone call for each dose. The problem with
this is that people get busy in their own lives and may
forget to make the phone calls. Still, the idea of phone
calls is a great one; most of us won’t go anywhere without a
cell phone anymore, so it makes sense that phone reminders
would work. I did an Internet search for “telephone reminder
calls” and “telephone wake-up calls” on Google, and came up
with many services that could be utilized for this purpose.
There are many different options and rates; the best I found
was a place called “MyCalls”. Their website is :
http://www.mycalls.net/index.asp
Pricing is by the minute or by the month (both are very
reasonable), depending on the plan selected. The patient can
choose the exact time of the calls, and can change these
times online or over the phone if needed. The patient can
set the ring-tone on his or her phone specifically for these
calls, so that they are not ignored.

I realize that most people don’t want another bill to pay
each month, especially if they are not working. But the
price paid for non-adherence to these medications is much
higher than what one of these plans would be. Realistically,
if someone can afford a cell phone, there is most likely a
way to fit a reminder call service into their budget. A
referral for Case Management services or Financial Planning
may be beneficial.

I am a Nurse Practitioner who has been caring for HIV/AIDS patients for the past 6 years, which I have found to be very rewarding - in fact, it’s my “niche”. Prior to that, I worked as a Nurse Practitioner in a Family Practice Clinic. I was a Registered Nurse for about 15 years prior to becoming a Nurse Practitioner, with most of my nursing experience in ICU/Critical Care and Oncology (Bone Marrow Transplant).