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Programs have shown that viral load monitoring may, in fact, help to preserve first-line regimens through intensified adherence counseling [8], [34], [35].
The factors included a comparison of three NRTI combinations (ZDV/lamivudine (3TC), ZDV/didanosine (ddI), and 3TC/stavudine (d4T)), a comparison of two NNRTIs (NVP and efavirenz (EFV)), and a comparison between two adherence strategies (standard of care (SOC) versus an intensified adherence strategy, SOC plus community-based supervision).
Most patients on second line ART experiencing VF were able to achieve virologic suppression with intensified adherence support in a study at a clinic in South Africa [ 21].
Whilst this month allowed time for intensified adherence counselling, it might also have provided opportunities for clinical progression and disengagement from care.
Of 47 health care workers among respondents, 13 (27.6%) intensified adherence to infection prevention guidelines at work during the monitoring period (mean ± SD intensified adherence in the high-risk group 1.3 ± 0.4 vs. 1.03 ± 0.2 in the low-risk group) (p = 0.006).
Several others (9%) have avoided inappropriate switch to second-line therapy after genotypic evidence of susceptibility to first-line ART and have instead received intensified adherence support (the effect of which can be seen in Case example 1).
Similar(54)
Ongoing HIV risk assessments of PrEP users may be important for informing uptake and intensifying adherence interventions during periods of higher risk.
Our study clearly shows that comprehensive baseline treatment preparation efforts needs to intensify adherence counseling, address anemia, male health seeking behavior, active case detection for opportunistic infections, affordable viral load testing, and regular CD4 cell count testing.
After two months, the visits were reduced to once per week (if treatment adherence was good) or intensified to become more frequent (if adherence was poor).
Bernard Haitink's reputation is so closely bound up with the late-Romantic self-absorption of Wagner, Mahler and Bruckner that it's easy to forget that he is also an outstanding interpreter of Brahms, whose remorseless emotional probing is both offset and intensified by his objective adherence to classical structure.
Focusing on intensified treatment preparation and adherence, young patients, males, persons with low educational status and most importantly baseline anemia assessment and management may help address predictors of poor immuno-virologic outcomes, and improve overall HIV program impact.
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