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In 2014, UNAIDS launched global 90-90-90 treatment targets for 2020: 90 percent of people living with HIV (PLWH) knowing their status, 90 percent on antiretroviral therapy (ART), and 90 percent virally suppressed.1 In the United States, ART is recommended for all PLWH, regardless of CD4 count, to reduce morbidity and mortality associated with HIV and to prevent HIV transmission.2 However, healthcare professionals (HCPs) must acknowledge and address patient fears, misconceptions, and other barriers to ART in order to optimize adherence.
Without ART, most PLWH develop progressive immunodeficiency and CD4 T lymphocyte (CD4) depletion.2 Effective ART reduces viremia; yet, in the current era of recommending ART immediately at diagnosis, especially at higher CD4 counts when patients may be asymptomatic, helping patients understand the importance of adherence is increasingly important.3
In addition to clinical barriers, several psychosocial factors may interfere with patient readiness to commit to ART3, 4:
- Lack of confidence to start or continue ART
- Low self-worth or psychological challenges
- Fear of side effects
- Fear of committing to long-term daily ART regimen
- Fear of drug resistance
- Internalized stigma
- Perceived good health
To increase patient readiness to start or maintain ART, HCPs may consider3, 4:Facilitating health literacy in patients, along with acceptance of HIV diagnosis and oneself Increasing awareness of current regimens with decreased side effects and high barrier to resistance Educating patients on the benefits of early ART initiation Promoting strong social support and increasing awareness of positive health effects of ART in peers Counseling patients to help them come to terms with a positive HIV result Treating patients with dignity and respect, listening, and communicating clearly
Find downloadable resources and links to help educate and empower patients to start and maintain ART.
1. Ending AIDS: progress towards the 90-90-90 targets. UNAIDS website. http://www.unaids.org/sites/default/files/media_asset/Global_AIDS_update_2017_en.pdf. Published July 20, 2017. Accessed May 7, 2018.
2. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. AIDSinfo website. https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/10/initiation-of-antiretroviral-therapy. Published May 30, 2018. Accessed June 20, 2018.
3. Maughan-Brown B, Smith P, Kuo C, et al. Readiness for antiretroviral therapy: implications for linking HIV-infected individuals to care and treatment. AIDS Behav. 2018;22(3):691-700. doi:10.1007/s10461-017-1834-2.
4. Christopoulos KA, Olender S, Lopez AM, et al. Retained in HIV care but not on antiretroviral treatment: a qualitative patient-provider dyadic study. PLoS Med. 2015;12(8). doi:10.1371/journal.pmed.1001863.