• Empower the client by including them in all decision-making processes.  
• Link with age-appropriate counselling and support services.  
• Involve friends and family members where appropriate.  

• Provide pragmatic suggestions such as planning the best time of day to take medication, or a practice run with a multivitamin before commencing antiretroviral therapy.  
• Allow the person to select their own start date.  
• Provide adherence aids such as dosette box or suggest a phone app as a reminder.  
• Provide evidence-based literature and information about the long-term effects of the regimen.  
• Provide future options such as LA ART.  

• Explore health beliefs and provide education with non-biased evidence-based information specific to needs and level of understanding.  
• Use a non-judgmental, non-coercive approach to foster engagement, taking into account the choices made by the person living with HIV and acknowledging the beliefs behind their decision.  
• Linking the person to an HIV specialist who will listen and nurture a respectful relationship.  
• Providing non-didactic education and empowering health promotion about HIV and related health issues. For example, encouraging immunisation, teaching people to recognise signs and symptoms of disease progression and assisting them to access medical care when needed.  
• Support and encouragement in health maintenance. For example, encouraging the person to agree to take prophylaxis to prevent opportunistic infections, despite choosing not to take antiretroviral therapy.  
• Health monitoring and crisis intervention including specialist referral if the client becomes unwell.  
• Linking with mental health services, community-based support, and other HIV-specific services such as housing and counselling.  

• Identify specific concerns around stigma.  
• Counteract myths around taking antiretroviral therapy and living with HIV.  
• Suggest counselling.  
• Normalise ART in the context of Pre-Exposure Prophylaxis (PrEP), Treatment as Prevention (TasP) and U=U  
• Refer to peer support group and networks.  
• Assist the person to develop strategies to minimise unwanted disclosure e.g. locked medication cabinet.  
• Explore multiple levels of influence – intrapersonal, interpersonal, structural. (26) 

• Suggest the client switches or simplifies regimens if possible.  
• Consider dosing requirements and pill burden, or if LA ART is a better option.  
• Devise a back-up plan with the client to manage a missed or delayed dose.  
• Assist client to manage side-effects if changing regimens is not possible.  

• Ensure clinical support is adequate to meet the client’s needs.  
• Consider a team care approach involving pharmacist, social worker, peer support service, community nursing service and GP.  
• Encourage client to attend peer support group.  
• Consider case conferences at structured intervals.  

Cost of living crisis in Australia at time of update to guideline (2024) may also impact access to care and ART.  

• For eligible Indigenous clients with chronic illness, antiretroviral therapy and all medicines are available free of charge through the Closing the Gap Pharmaceutical Benefits Scheme (PBS) Co-payment measure. (28)  
• Ensure financial support is provided in other areas of life where possible such as a subsidised taxi card if eligible, access to free or subsidised food.  
• Simplify antiretroviral therapy regimen to reduce pharmacy dispensing fee.  
• Refer for financial counselling and support.  

• Engage the client’s mental health-care team.  
• Adopt a team care approach.  
• Explore adherence aids.  
• Develop a plan of care with the client, and a plan of action in the event of an exacerbation of their mental illness.  

• Engage social work and other allied health support.  
• Assess support to access and maintain stable housing.  
• Provide dietary education and linkage to community agencies that provide subsidised or free food and meals.  

ATS use has been described as a barrier to adherence among gay and bisexual men. This may be both planned and unplanned non-adherence. (32) 

• With client’s consent, engage with pharmacotherapy provider and pharmacist to provide additional support.  
• Consider a planned treatment break with increased health monitoring in consultation with the client’s physician as this may reduce the risk of developing medication resistance if unable to maintain adherence and all other avenues of support have been exhausted.  

• Referral and assessment for HAND and other organic causes of cognitive impairment, which may include the recommendation of changing ART regimen.  
• Use of reminders i.e. use the smart phone calendar, set an alarm clock, leave notes in a visible place, involve carer or significant others to remind the person or to administer if required.  
• Refer to a community-based nursing service to support and promote adherence, to coordinate medication management and administer medication regularly if required.  

• Ensure education is appropriate to the client’s level of comprehension.  
• Engage pharmacist, other clinical or allied health-care providers involved in client’s care to provide a team care approach.  
• Introduce supportive strategies such as keeping a diary of dosing and any questions for the next appointment with the physician or nurse.  

• Explore cultural beliefs around health, illness, and medication and incorporate into adherence counselling sessions.  
• Engage community members or elders if appropriate. 
• Ensure CALD resources are available.  
• Use an interpreter service ensuring appropriate confidentiality provisions are in place beforehand.  
• Consider cultural implications regarding pregnancy and breastfeeding.  

• Introduce a dosette box or other dosage administration device. 
• Engage the pharmacist and a team care approach. 
• Arrange Home Medicine Review through client’s GP. 
• Simplify antiretroviral therapy regimen where possible.  

Poorly managed symptoms or early toxicities can lead to poor adherence and influence people’s decisions to seek and remain engaged in care. (37) 

• Support through initial side-effects post- antiretroviral therapy commencement by providing anti-emetic, anti-diarrhoeal and   temporary dietary restrictions as required.  
• Ask the client to keep a diary of adverse effects, noting pattern, frequency, any relieving or exacerbating factors, and if any were present before commencing antiretroviral therapy.  
• Consider changing regimens or the time of dosing i.e. before bed if sedating side-effects are being experienced.  

• Liaise with all members of the care team from all disciplines to stay abreast of medication changes.  
• Educate client about drug-drug interactions with an emphasis on over-the-counter remedies such as antacids and herbal medicine.  
• Suggest Liverpool drug interactions website or phone app.  

• Client education about food, vitamin, and supplement interactions with antiretroviral therapy.  
• Review drug regimen, change antiretroviral therapy or time of dosing.  
• Dietitian referral.  
• Ensure the client has access to food and basic amenities.  

Physical access to a service may also pose a barrier for an individual living with a disability.  

Specific settings such as prison, immigration detention or other institutional settings may thwart or support adherence. (38) 

• Consider referral to a local provider or telehealth conferences.  
• Consider using the local pharmacy for medication collection.  
• Ensure the health services the client is accessing are aware of specific needs.  
• Outreach of HIV specialist teams to custodial settings.  

• Educate and dispel myths about HIV among clinicians.  
• Ethical consciousness-raising. (40, 41) 

dosing errors and drug interactions. (43) 

Consequences can include:  

o   Drug resistance  

o   Treatment failure  

o   Toxicities  

o   Loss of trust  

o   Increased costs  

o   Legal implications. (44) 

• Enhanced medication reconciliation upon admission or discharge from hospital or other transitions or settings (respite, aged care). (45) 
• Nursing consultation with HIV specialist pharmacists.  
• HIV nurses supporting, educating, and mentoring general nursing staff.  
• Improved data collection, analysis of medication errors.  
• Attention to factors contributing to errors: interruptions, communication, lack of adequate medication reconciliation processes and procedures. (46) 

• Referral to community nursing services with expertise in HIV can be an important early intervention for those identified as at risk of poor adherence.  
• Involvement of community sector (e.g. HIV organisations, Peer Services, local services) to provide supports such as transport. 
• Professional and industrial nursing advocacy for appropriate staffing levels, skill mix.  

• Family dysfunction  
• Criminalisation of drug use  
• Homelessness  
• Poverty  
• Cost shifting  

• Refer for social work and counselling.  
• Support in accessing legal, housing, and financial services. 
• Structural advocacy.