Clinicians are reminded that such factors as gender, race, socio-economic status, educational level, and a past history of drug use do not reliably predict poor adherence. No individual patient should automatically be excluded from consideration from antiretroviral therapy simply because he or she exhibits a behavior or other characteristics judged by some to lend itself to nonadherence. A trusting relationship is essential. The clinician should commit to a feasible mechanism for communication between clinic visits, to ongoing monitoring of adherence, and to timely and appropriate responses to adverse events or interim illness. Interim management during physician vacations or other absences must be clarified.
Adherence requires full deployment of the available health care team.
Regular reinforcement by two or more team members will assist the goals of adherence. Provider attitudes and behaviors that are supportive and non-judgmental will encourage patients to be honest about their adherence and about problems they have experienced with adherence. Monitoring may identify periods of poor adherence. Thus monitoring adherence at every clinical encounter is essential. Intermittent drug use or emotional crisis might lead to referral for mental health or chemical dependency assessment or further recruitment and intervention with family or friends.