Ed Simpauco Lecture

1. SHIP
Telehealth Training
httpAugust 2018Ed (SHIP Clinic)

2. httpAugust 2018Ed (SHIP Clinic)
What you need to know!
ARV Adherence

3. ARV Adherence. Adherence
definition.
Resistance to ARV.
Assessment of ARV Adherence
Determinants. Strategies to
promote adherence.
Other facts about ARV adherence.
Topic Outline
Things to learn

4. ARV in the Philippines
Current medications available
A B C
• Abacavir (300mg, BID)
• Lamivudine(150mg, BID or
300mg, OD)
• Tenofovir Disoproxil
Fumarate (300mg, OD)
• Zidovudine (150mg, BID or
300mg, OD)
• Efavirenz (600mg, OD)
• Nevirapine (200mg, BID)
• Rilpivirine (25mg, OD)
• Lopinavir/Ritonavir
(200mg/50mg, 2 Tabs BID)

5. ARV in the Philippines
Other ARV medications by Filipinos
D E F
• Cobicistat(150mg, OD) • Elvitegravir(150mg,
OD)
• Dolutegravir(50mg,
OD)
• Raltegravir(400 mg or
600 mg, BID)
• Emtricitabine(200mg,
OD)

6. ARV Adherence
the basics
Medication adherence is
generally defined as the extent
to which patients take
medication as prescribed by
their doctors.
≥ 95%Source: Bangsberg, D.R. (2006). Less Than 95%
Adherence to Nonnucleoside Reverse-Transcriptase
Inhibitor Therapy Can Lead to Viral Suppression. Clinical
Infectious Diseases. 43, 939–941.
This involves factors such as
getting prescriptions filled,
remembering to take
medication on time, and
understanding the directions.
Viral suppression is defined as
less than 200 copies/mL or
undetectable levels of HIV
Viral Load

7. Note:
“Although viral suppression may
possible with moderate adherence,
the probability of viral suppression
and reduced disease progression
and mortality improves with every
increase in adherence level”

8. Individual factors
ART regimen and
treatment experience
Disease characteristics
01
02
03
ARV Adherence
Determinants

9. Social support
Patient provider
relationship
Informational resources
04
05
06
ARV Adherence
Determinants

10. Healthcare
environment
Health beliefs
07
08
ARV Adherence
Determinants

11. ARV Adherence Determinants
Socio-demographics
• Basic Needs
• Economic Factors
• Education
• Cultural beliefs, values,
practices
Socio-demographics
• Cognitive Factors
• Psychological Factors
• Substance Abuse
ART Regimen and
Treatment Experience
• Adverse Drug Effects
• Early Toxicity
• Treatment Fatigue
• Regimen Complexity
ART Regimen and
Treatment Experience
• Non-adherence History
• Missed Medical
Appointments History

12. ARV Adherence Determinants
Disease Characteristics
• Symptoms
• Immune Status
• Illness Severity
Social Support
• Disclosure Status
• Support from Friends
• Family Support
• Partner Support
Patient-Provider
Relationship
• Provider Competence
• Trust
• Communication
• Inclusion of Patient in
Decision-Making
Informational Resources
• Education and Information
About ARVs, Side Effects
and Their Management

13. ARV Adherence Determinants
Healthcare Environment
• Accessibility
• Convenience
• Confidentiality
• Adherence Services at the
Clinic
Health Beliefs
• Purpose of Treatment
• Treatment Effectivity
• Treatment Experiences
• Self-Efficacy
Source: (1) Tessa Heestermans, Joyce L
Browne, Susan C Aitken, Sigrid C
Vervoort, Kerstin Klipstein-Grobusch,
Determinants of adherence to
antiretroviral therapy among HIV-
positive adults, 2016
Source: (2) Levine, et al., 2015

14. Effective Treatment
Viral Suppression
HIV before ARV Effective Treatment Viral Suppression

15. Adherence/Resistance
Relationship

16. Adherence/Resistance
Relationship

17. Promote Good Adherence
Tips
1
2
3
SOCIAL/PROVIDER SUPPORT –
Collaborate with a team.
MENTAL HEALTH/SUBSTANCE ABUSE –
Refer as needed.
LIFESTYLE – Fit regimen to lifestyle.

18. Promote Good Adherence
Tips (cont.)
4
5
6
SEVERITY– Educate adherence in
reference to resistance.
BENEFITS– Reinforce benefits of
adherence.
SUSCEPTIBILITY – Develop accurate
perception of risk.

19. Promote Good Adherence
Tips (cont.)
7
8
9
EDUCATIONAL AIDS– Detailed, specific,
and simple information.
REGULAR ASSESSMENT– Provide
regular assessment & counselling.
BARRIERS – Enumerate all possible
barriers.

20. World Facts
There were no significant differences
in the pooled odds ratios among
different optimal adherence
thresholds (≥98–100%, ≥95%, ≥80–
90%). Source: Kahana SY, Rohan J, Allison S, Frazier TW, Drotar
D
AIDS Behav. 2013 Jan; 17(1):41-60.
Optimum adherence presents a
barrier for initiation of therapy. Source:
Kurth AE, Mayer K, Beauchamp G, McKinstry L, Farrior J, Buchacz K,
Donnell D, Branson B, El-Sadr W, HPTN (065) TLC-Plus Study Team.
J Acquir Immune Defic Syndr. 2012 Dec 15; 61(5):e65-9.
At least 95% adherence is required for
virologic suppression. Source: Paterson DL, Swindells S, Mohr J,
Brester M, Vergis EN, Squier C, Wagener MM, Singh N Ann Intern Med. 2000 Jul
4; 133(1):21-30.

21. World Facts
Relationship between adherence and
resistance differ substantially between
drug classes. Source: Mellors, J., Palmer, S., Nissley, D. et
al. (2003). Low frequency non-nucleoside reverse transcriptase
inhibitor (NNRTI)-resistant variants contribute to failure of efavirenz-
containing regimens in NNRTI-experienced patients with negative
standard genotypes for NNRTI mutations. Antiviral Therapy 8, S166.
Patients on ART would not become
less adherent once they feel better.
Source: Determinants of heterogeneous adherence to HIV-
antiretroviral therapies in the Multicenter AIDS Cohort Study.
Kleeberger CA, Phair JP, Strathdee SA, Detels R, Kingsley L,
Jacobson LP J Acquir Immune Defic Syndr. 2001 Jan 1; 26(1):82-92.
Adherence is 1.74 times higher in patients
from cohesive families. Source: Social support and patient
adherence to medical treatment: a meta-analysis.
DiMatteo MR Health Psychol. 2004 Mar; 23(2):207-18.

22. END OF PRESENTATION
Presentation by: Ed (SHIP
Clinic)
Lecture Date:
August 30, 2018
SHIP Clinic
Mandaluyong City
For many Filipinos living with HIV, finding the right healthcare provider is one of the
most important decisions they will make. Be one those providers! – Ed, 2018