Viral load monitoring shown to be an effective way to boost compliance in HIV patients
Even when ARVs are available, patient compliance has always been a
problem. Some programs go to the extreme of having a nurse supervise every
dose, every day. The reason it’s such a big deal is that even missing a few
doses gives HIV the chance to adapt to the medication and develop resistance.
Treatment options are limited and expensive, especially in developing
countries.
So why are patients putting their own lives at risk by skipping doses?
Sometimes it’s a money issue. Sometimes it’s a lack of knowledge about the
drugs and their disease. Sometimes it’s because of the side effects. But in the
end, we don’t know what they do when they take the drugs and go home. When
their doctors inquire about their compliance, they often just say what the
doctor wants to hear. Which makes it difficult to know before it’s too late
which patients need extra help to consistently take their ARVs.
A recent study from Doctors Without Borders has shown that viral load
monitoring may be the solution. A group of HIV patients in Thailand were put on
monitoring for the first time. Many of them showed detectable viral loads. Most
of these were linked to poor compliance.
By monitoring viral load, doctors were able to see quite early which
patients were not responding well to treatment. With this knowledge they could
single them out for counseling early on in their treatment regimen. Moreover,
the patients’ viral load could be used as a tool to educate and motivate the
patient during counseling.
Virtually all of the patients who were given extra counseling in this
manner saw their viral load drop to undetectable levels indicating better
compliance. The few who didn’t were flagged as non-responsive and put on second
line treatment. This reduced the chance of drug resistant strains developing
and being passed on, and avoided wasting valuable drugs that were no longer
effective for those patients.
In an ideal world, patients would follow their doctor’s instructions to
the letter and they’d be honest about everything to do with their
treatment. But that’s not the world we live in. In the interest of public
health, for both individuals and populations as a whole, we should explore
these potential solutions to nagging problems wherever we find them. Especially
when it is as easily addressed as this issue is.
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