Jessica Robinson-Papp, MD, MS, professor of neurology at Icahn School of Medicine at Mt. Sinai, talks about what factors can contribute to medication nonadherence in people with HIV, and the different levels of support that might be available to patients.
Different barriers patients face can contribute to medication nonadherence in people with HIV, and there are different levels of support available, says Jessica Robinson-Papp, MD, MS, professor of neurology at Icahn School of Medicine at Mt. Sinai.
Your presentation highlights a case of toxoplasmosis that recurred after the patient was nonadherent to their treatment plan. As medication adherence is already a struggle for many patients with HIV for a variety of reasons, what can clinicians do to improve treatment adherence for patients with HIV-associated neurologic disorders?
I think trying to understand what the barriers for that particular patient are is really the first step, because it's different for everyone. Sometimes patients can articulate [a barrier], and sometimes they have trouble. When I have patients that have trouble with adherence to medications, I'll start by just trying to ask them, "What do you think the problem is? What are you having difficulty with? Can you explain to me what happens?"
Sometimes it is something that might be fairly easily fixable. Maybe it's lapses of insurance coverage, or difficulty with having the pharmacy deliver their pills on time, or forgetting. So, there's different layers that you can intervene on there. A lot of our patients will get their medications prepackaged, so maybe they need to go into blister packs. Or, maybe they need someone to help them at home more. Sometimes we go so far as to even have directly observed therapy. That can be useful sometimes, just to have someone check in with them daily. Sometimes patients don't exactly know, and there's a fatigue associated with a lifelong illness that you have to take a medication for every day, and that is accompanied by a lot of stigma that patients experience.
Sometimes it's depression, or it's mental health issues; they just can't take it every day. That is much harder to deal with, because the answer isn't clear. Sometimes it's supporting them; just trying to continue to reach out and being nonjudgmental. Especially in patient populations that have been stigmatized and marginalized, we try to really adopt a harm reduction approach where we're not scolding people. What we want is whatever it takes to help that patient have their best health.
So, it's very individualized and it's very team based. Fortunately, medication adherence in HIV is a topic that is very well studied, and there's a lot of interest in it, so many clinics will have specific resources, care coordinators, support services to try and help with adherence, and so you can tap into those people as well.