Breaking Barriers to Medication Adherence in HIV: An Interview With Robert Gross, MD

Robert Gross, MD; Shira Berman


August 05, 2013

In This Article

Editor's Note: Adherence to HIV medications is key to improved treatment outcomes, but a variety of barriers can impede good adherence in different populations. This issue was one of many topics discussed during sessions at the 8th International Conference on HIV Treatment and Prevention Adherence, held in June 2013 in Miami, Florida.

In an interview with Medscape, Robert Gross, MD, Associate Professor of Medicine at the University of Pennsylvania Perelman School of Medicine in Philadelphia, reviewed some of the key barriers to medication adherence in HIV-positive patients and discussed strategies for overcoming these barriers in different patient populations.

Medscape: One of the panel discussions at the conference focused on how clinicians can address barriers to medication adherence in people living with HIV. Of all of the barriers to care, why is this one so important?

Dr. Gross: Barriers to care can occur at any step. There could be barriers to getting tested and determining the need for care. There could be barriers to linkage -- finding a provider who knows how to deliver effective care. There could be barriers to retention -- the patient staying in care and the clinic keeping the patient in care. And then there's the issue of adherence to therapy. This is so challenging to address because there is no one barrier that interferes with medication adherence. Although there are certain universalities regarding adherence, barriers to adherence can play out very differently within different populations.

For example, one person in the audience talked about seeing a patient reading from a bible in the waiting area. The physician learned later that the patient was actually illiterate and was flipping through pages of the bible as part of a prayer mechanism. The lesson here was that it is important to be aware of the cultural setting and recognize the ways in which providers can be misguided in trying to help patients because they mistake the cues that patients might be sending.

Also, an individual patient can have multiple barriers and have multiple different needs for overcoming those barriers. This is why interventions that work tend to be those that are tailored to each individual's problems and reasons for nonadherence. It is unlikely that we will have a silver bullet for improving adherence across the board. It's really going to need to be tailored to each individual's barriers and characteristics.