Adherence to a medication regimen can be defined as ‘the extent to which patients take medication as prescribed by health care providers’.(1) Continuous adherence to combination antiretroviral therapy (ART) is paramount to its success in effectively treating human immunodeficiency virus (HIV), achieving virological suppression, preserving immune function, avoiding drug resistance and preventing opportunistic infections.(2) More broadly, it can confer a public health benefit by reducing what is referred to as community viral load (CVL). Community viral load can be defined as ‘an aggregation of individual viral loads of HIV-infected persons within a defined community. (3)  A decrease in community viral load will considerably reduce the likelihood of HIV transmission in that community. (4-6) 

Missed doses, treatment breaks or interruptions, drug holidays, non-use, or reluctance to commence antiretroviral therapy pose considerable challenges for clinicians.  The consequences of inadequate adherence to antiretroviral therapy to the individual can include the development of drug resistance which may limit the person’s later choice of effective antiretroviral therapy regimen, development of opportunistic illnesses and increased risk of morbidity and mortality. (7) 

Many factors contribute to successful antiretroviral therapy adherence, and these include thorough assessment both at treatment initiation and at ongoing clinical encounters, clinical care whereby the patient is engaged and feels comfortable with their clinician of choice, and ongoing adherence counselling, education and assessment of side effects, early toxicities, psychosocial complexities, and other factors which may impact on continuous adherence.(8, 9) The World Health Organization (WHO) advises assessing adherence with each patient interaction.(10) Nurses are integral to this process given the dynamic role they play in patient care.  

The START Study findings (May 2015) demonstrated that starting antiretroviral therapy regardless of CD4 count for all individuals diagnosed with HIV is preferable to delaying treatment commencement as previously recommended, and as such changed both national and international guidelines on ART initiation.(11) Following this came the findings from the HPTN 052, PARTNER and Opposites Attract studies, demonstrating amongst both heterosexual and men who have sex with men (MSM) populations that where the partner living with HIV has a sustained suppressed HIV viral load (<200 copies/mL), no linked HIV transmission occurred across either of these three landmark clinical trials, leading to the concept of “U=U” (Undetectable Equals Untransmittable).(12, 13) With strong evidence to support early treatment initiation and the rationale behind strict adherence, adherence support must remain a component of care from the outset for every person living with HIV.