2.0 Why is there a need for guidelines on adherence support?

As the central role of adherence to the success of HAART has become increasingly apparent, many HIV organisations (both statutory and non-statutory) have established services in an attempt to support patients in adhering to their regimens. Implementation of the Government’s National Strategy on Sexual Health and HIV will give rise to further changes in commissioning of HIV services. Within this context, this document’s goal is to clarify appropriate aims and objectives for such services, and ensure equity of service provision and benefits of HAART across the UK.

As new agents and formulations of existing agents become increasingly available, there will be more options for regimens believed to be easier to adhere to. This document reviews the data regarding such issues as pill burden and dosing frequency, to ensure that such developments are introduced in an evidence-based manner, rather than one based upon assumptions.

Whilst the importance of adherence in achieving treatment success is acknowledged in treatment guidelines18, our understanding of factors associated with high adherence and low adherence are less clear, and the literature concerning interventions is remarkably scarce. There are currently few randomised controlled trials that have studied interventions to improve adherence to HAART, and it is therefore necessary to consider studies from other chronic disease areas in order to ensure that adherence support services are evidence-based wherever possible.

The terms low and high adherence are used throughout this document in preference to adherence and non-adherence. High adherence describes adherence levels which would be expected to enable successful treatment responses, and low adherence describes adherence levels below this.