Spending More to Save More: Interventions to Promote Adherence
Authors: David R. Bangsberg, Steven G. Deeks
Journal: Annals of Internal Medicine (2010)

Editorials5 January 2010Spending More to Save More: Interventions to Promote AdherenceDavid R. Bangsberg, MD, MPH and Steven G. Deeks, MDDavid R. Bangsberg, MD, MPHFrom Massachusetts General Hospital, Boston, MA 02114; and University of California, San Francisco, San Francisco, CA 94110.Search for more papers by this author and Steven G. Deeks, MDFrom Massachusetts General Hospital, Boston, MA 02114; and University of California, San Francisco, San Francisco, CA 94110.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-1-201001050-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Medicine often balances patient and population interests. Resource-rich areas, such as the United States, often focus on maximizing benefit for the individual patient, whereas resource-limited settings, such as sub-Saharan Africa, often focus on maximizing population benefit (1). In a data-driven analysis of adherence behavior, disease outcomes, and health care use in this issue, Nachega and colleagues (2) demonstrate that these pressures do not necessarily conflict. They provide compelling data indicating that increasing resources to enhancing HIV-infected patients' antiretroviral adherence is associated with substantial cost savings for the entire public health system.Among HIV-infected persons, antiretroviral treatment adherence strongly predicts viral ...References1. Gilks CF, Crowley S, Ekpini R, Gove S, Perriens J, Souteyrand Y, et al. The WHO public-health approach to antiretroviral treatment against HIV in resource-limited settings. Lancet. 2006;368:505-10. [PMID: 16890837] CrossrefMedlineGoogle Scholar2. 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Longitudinal antiretroviral adherence in HIV+ Ugandan parents and their children initiating HAART in the MTCT-Plus family treatment model: role of depression in declining adherence over time. AIDS Behav. 2009;13 Suppl 1 82-91. [PMID: 19301113] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Massachusetts General Hospital, Boston, MA 02114; and University of California, San Francisco, San Francisco, CA 94110.Grant Support: By the National Institute of Mental Health, grants RO1 54907 and K-24 87227, and The Mark and Lisa Schwartz Family Foundation (Dr. Bangsberg) and the National Institute of Allergy and Infectious Diseases, grants RO1 and K24AI069994 (Dr. Deeks).Disclosures: None disclosed.Corresponding Author: David R. Bangsberg, MD, MPH, Harvard Initiative for Global Health, 104 Mount Auburn Street, Cambridge, MA 02138; e-mail, [email protected]edu.Current Author Addresses: Dr. Bangsberg: Harvard Initiative for Global Health, 104 Mount Auburn Street, Cambridge, MA 02138.Dr. Deeks: San Franciso General Hospital, 995 Potrero Avenue, Building 80, Ward 84, San Francisco, CA 94110. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAssociation of Antiretroviral Therapy Adherence and Health Care Costs Jean B. Nachega , Rory Leisegang , David Bishai , Hoang Nguyen , Michael Hislop , Susan Cleary , Leon Regensberg , and Gary Maartens Metrics Cited BySocio-demographic, clinical and service use determinants associated with HIV related stigma among people living with HIV/AIDS: a systematic review and meta-analysisProtocol of the randomized control trial: the WiseApp trial for improving health outcomes in PLWH (WiseApp)PMTCT Adherence in Pregnant South African Women: The Role of Depression, Social Support, Stigma, and Structural Barriers to CarePilot evaluation of a second-generation electronic pill box for adherence to Bedaquiline and antiretroviral therapy in drug-resistant TB/HIV co-infected patients in KwaZulu-Natal, South AfricaSocial Capital, Depressive Symptoms, and HIV Viral Suppression Among Young Black, Gay, Bisexual and Other Men Who Have Sex with Men Living with HIVUnderstanding Treatment Refusal Among Adults Presenting for HIV-Testing in Soweto, South Africa: A Qualitative StudyImpacto da frequência posológica na adesão terapêutica em doenças cardiovasculares crónicas: revisão sistemática e meta‐análiseThe impact of dosing frequency on medication adherence in chronic cardiovascular disease: Systematic review and meta-analysisTargets for intervention to improve virological outcomes for patients receiving free antiretroviral therapy in Tamil Nadu, IndiaImpact of HIV-related stigma on treatment adherence: systematic review and meta-synthesisGlobal Action to reduce HIV stigma and discriminationReal-Time Electronic Adherence Monitoring is Feasible, Comparable to Unannounced Pill Counts, and AcceptableStudies of Medication AdherenceThe social context of food insecurity among persons living with HIV/AIDS in rural UgandaBarriers to antiretroviral therapy adherence in rural MozambiqueFood Insufficiency and Medication Adherence Among People Living with HIV/AIDS in Urban and Peri-Urban SettingsReal-Time Adherence Monitoring for HIV Antiretroviral TherapyMonthly Unannounced Pill Counts for Monitoring HIV Treatment Adherence: Tests for Self-Monitoring and Reactivity Effects 5 January 2010Volume 152, Issue 1Page: 54-56KeywordsAntiretroviral therapyAntiretroviralsDrugsFoodGlobal healthHIVHealth careHealth economicsPrevention, policy, and public healthTreatment guidelines ePublished: 5 January 2010 Issue Published: 5 January 2010 CopyrightCopyright © 2010 by American College of Physicians. 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