Conceptualizations of Adherence and Its Correlates
نویسندگان
چکیده
Numerous reports have documented that combinations of antiretroviral medications can inhibit HIV replication and result in precipitous declines in HIV-associated morbidity and mortality. However, the high degree of success with antiretroviral therapy in achieving HIV-1 RNA levels below assay detection limits reported in clinical trials (ie, 60%–90%) has seldom been achieved in everyday practice. Indeed, studies in primary care settings suggest that, on average, only 50% of patients achieve HIV-1 RNA levels below detection limits. A primary reason for the lack of success in clinical practice appears to be either intentional or non-intentional poor adherence to medication regimens. The level of antiretroviral therapy adherence needed to obtain optimal long-term benefits appears to be over 90%. Compared with therapy for most other clinical conditions, antiretroviral therapy requires an unprecedentedly high level of adherence for an indefinite time period to achieve optimal viral suppression. Consequently, adherence has proven to be the Achilles’ heel of antiretroviral therapy. Adherence to demanding antiretroviral regimens requires substantial support and monitoring. Effective approaches to promote and improve patient adherence to antiretroviral therapy are the focus of intensive, time-consuming research. Most intervention studies are still incomplete. Nonetheless, results from available studies can offer instructive examples for clinicians and patients to consider while awaiting more definitive results. In this review of the emerging research on interventions to improve antiretroviral adherence, we consider various conceptualizations of adherence and its correlates as well as interventions designed to enhance adherence. We review published reports as well as summaries of ongoing federally funded studies and conclude with recommendations for practice and directions for future research.
منابع مشابه
Cultural Linguistics: Cultural Conceptualizations and Language, Farzad Sharifian (2017), John Benjamins, ISBN 9789027204110
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تاریخ انتشار 2003