Barriers to adherence and intentional non-adherence: a guide for nurses

Robert Downes and Elizabeth Foote
Clinical Nurse Specialists HIV Community, Royal Liverpool and Broadgreen Hospitals NHS Trust

Since the identifi cation of HIV in 1983, the HIV fi eld has changed dramatically and HIV is no longer classed as palliative but as a long-term condition. HIV continues to be an important public health issue in the UK. Although diagnosis can be traumatic we can now offer people hope. If patients are diagnosed early and antiretroviral therapy (ART) is initiated their prognosis is extremely good. Treatment outcomes for people with HIV are amongst the best in the world. Ultimately as healthcare professionals, our aim is to promote a healthy lifestyle, to deliver high-quality care and to enable people to live long and healthy lives. So how do we approach and manage patients who choose to opt out of treatment (intentional non-adherence) or struggle with adherence?
A new report published by Public Health England (PHE) showed that the UK is one of the fi rst countries to meet the UNAIDS 90-90-90 targets [1] , highlighting that prevention efforts are working in the UK. In 2015 it was estimated that there were 101 200 people with HIV in the UK, of whom 13% were unaware that they were living with HIV [1] . New estimates revealed that in 2017, 92% of people living with HIV in the UK have been diagnosed, 98% of those diagnosed were on treatment, and 97% of those on treatment were virally suppressed. Of all people living with HIV, 87% have an undetectable viral load and are unable to pass on HIV to other people, widely known as ‘Undetectable equals Untransmissible’ or ‘U = U’ [2] . However the authors estimate that there are still almost 3600 people diagnosed with HIV who have detectable viral loads. Read more…