Adherence

Taking medicine as directed, also known as medication adherence, is critical to achieve good health outcomes for patients. However, staying on medication and adhering to treatment regimens can be a challenge, especially for patients with chronic or long-term health conditions. The World Health Organization estimates that as many as 50% of all patients do not or are unable to take medicines as intended by their health provider.

When a full course of treatment is not completed or medicines are used improperly, it can result in poor health outcomes for the patient, longer and more costly treatment regimens, and also contribute to the development of antimicrobial resistance. Adherence to medication is a multidimensional issue related not only to the patient, but also the health care provider, the disease for which the patient is being treated, and the health system. For that reason, interventions to improve adherence require a multidisciplinary, systems strengthening approach to address the many reasons non-adherence occurs.

SIAPS and its predecessor programs—SPS and RPM Plus—have helped to address treatment adherence in 14 countries and through regional initiatives in the Amazon Basin, East Africa, and Latin America and the Caribbean. Working with both public and private institutions at the regional, national, and community levels, these programs have focused on building capacity through pre- and in-service trainings; assessing adherence levels; developing effective tools and job aids; and conducting research on adherence measurement methodologies and incentive strategies.

Pre-service and in-service trainings have been conducted in eight countries to strengthen the capacity of pharmacy students, pharmacists, physicians, and community health workers to encourage treatment adherence through education, counseling, and monitoring. SIAPS and its predecessor programs have also supported the development and implementation of tools, job aids, and pharmaceutical care programs to help improve, measure, document, and monitor adherence levels.

Leveraging previous work conducted by SPS on HIV treatment adherence in resource-constrained settings in South Africa, SIAPS has adapted a medication adherence tool to train adherence officers and treatment supporters in Swaziland to encourage adherence to TB treatment regimens.

Similarly, SIAPS is assisting stakeholders in Namibia to use an Electronic Dispensing Tool (EDT) platform to monitor HIV-drug resistance early-warning indicators (HIV-DR EWIs), including those that provide proxy data on adherence to antiretroviral therapy.