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HIV/AIDS

The Adherence Support Gap: The `Ideal' Versus `Reality' of Antiretroviral Adherence Support Provided by HIV Health Providers in Clinical Practice

Department of Family and Community Medicine, St. Michael's Hospital; Research Fellow, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital; Research Fellow, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

Derek Kam, MPhil

Centre for Research on Inner City Health, St. Michael's Hospital

Ahmed M Bayoumi, MD MSc

Scientist, Keenan Research Centre; Program Director, Clinical Epidemiology and Health Care Research Program, Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto

Reprints: Dr. Park-Wyllie, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St., Toronto, ON M5B 1W8, Canada, fax 416/864-6057, parkwylliel{at}smh.toronto.on.ca

BACKGROUND: Guidelines suggest that clinicians should provide their patients with antiretroviral adherence support, but there is uncertainty about the types of adherence support clinicians think are important, the methods they use to provide adherence support, and the barriers they face in providing such support in clinical practice.

OBJECTIVE: To study clinician perspectives on the importance of different antiretroviral adherence support activities and compare these with clinicians' self-reported actual adherence support practices.

METHODS: From March to August 2005, surveys were mailed to physicians, pharmacists, and nurses who provide care to HIV patients in Ontario, Canada. The 84-item survey asked providers to rate how necessary it was to provide 30 types of adherence support activities and how frequently they actually provided each of the types of adherence support. From this, we assessed healthcare provider perceptions of best or ideal practices in supporting medication adherence and actual or usual care in adherence support provision. We also examined whether an adherence support gap existed between the provision of best practice adherence support and actual adherence support in clinical practice.

RESULTS: One hundred sixty-nine of 300 mailed surveys were returned, for a response rate of 56%. Respondents were highly specialized in HIV care and nearly all practiced in urban settings. Respondents indicated that most of the surveyed adherence support activities should be provided to all patients. However, most clinicians did not actually provide these adherence supports to their patients to the extent that they desired. We calculated an adherence support gap that ranged from 31% to 75% across the different types of adherence support activities.

CONCLUSIONS: We observed important adherence support gaps between ideal best practices in the provision of adherence support and actual provision of adherence support in clinical practice.

Key Words: adherence, antiretrovirals, HIV/AIDS

Published Online, June 2, 2009. www.theannals.com, DOI 10.1345/aph.1L663