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Special Considerations
Women and cART
Adherence to Treatment
 What is medication adherence?
‐ taking medication exactly the way it is prescribed by the doctor
‐ taking the right amount of medication at the right
time in the right way ‐ being consistent and not missing any doses
Adherence to Treatment
 Why is Adherence Important?
‐ missing doses may affect the amounts of
medication in the body inhibiting the ability of the medication to work properly = leads to
an increase of the virus in the body
‐ increased risk of transmission when not virally supressed
‐ missed doses can cause HIV to reproduce more
actively and the virus may change forms (mutate), causing HIV medications to become ineffective 1
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Barriers to Medication Adherence  Over half of the global population of people infected with HIV consists of women and girls  Women face a wide variety of barriers that are gender specific to this population
 Social, cultural, economic and environmental factors all influence access to treatment and adherence to medication regime “To achieve current global goals, it is critical to understand and address key barriers to and facilitators of women’s access to HIV treatment.”
Barriers to Medication
Adherence  Fear of stigma discrimination
‐ may lead to non‐disclosure of HIV status which may interfere with adherence ‐women from marginalized groups (ex: sex workers, transgender women, women who inject drugs) are at increased risk of contracting HIV
‐ face high levels of stigma and discrimination in health
care settings
 Side effects of HIV medication
‐ medications can have a wide variety of unpleasant
side effects
‐ changes in body shape, weight gain, changes in mental health, dermatological changes and
nausea Barriers to Medication Adherence
 Medication regime
‐ medication regime may interfere with one’s daily schedule (Ex: eating and taking meds at certain
times of day)
‐ may seem overwhelming on top of caregiving and household duties  Social relationships
‐juggling caregiving responsibilities with regime
adherence
‐ If someone has not disclosed their status to friends, family or partner this poses challenge
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Barriers to Medication Adherence
 Medication beliefs
‐ may be a cultural factor
‐ some women report that they believe HIV meds
are toxic or ineffective  Violence and Fear of Violence
‐ violence is increased among women with HIV
‐disclosing status can lead to increased violence
‐women may lack a “safe place” to store and take medications
Barriers to Medication
Adherence  Economic challenges ‐ inability to meet daily needs such as food security,
housing, transportation, etc. ‐ lack adequate funds to pay for medications
‐ many women reported prioritizing children’s needs over their own needs in achieving adherence  Gender roles and responsibilities ‐ some women may need to ask permission from
husbands or family members ‐ lack of access and control of resources Barriers to Medication
Adherence  Violations of rights to privacy & confidentiality ‐violations in health care settings is a major concern for patients and may inhibit them from
accessing care in the future
‐ violations may include: disclosing HIV status in front of family members, other staff, and clients
refusing to care for client, human rights during and after labour, as well as forced and coerced sterilization 3
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Barriers to Medication
Adherence  Poor communication in healthcare
‐ limited time or effort from healthcare providers to address woman’s concerns and provide proper health teaching on the benefits and complications of medication
‐ many women also reported a lack of counselling  Mental health & self‐stigma
‐women reported experiencing internalized stigma, depression, low‐self esteem and other mental health issues
Common Side Effects Among Women
 Women experience an increased risk of many side effects which include:
‐ lipo dystrophy
‐ rash or hypersensitivity ‐ nausea
‐ weight gain
‐ metabolic disorders
‐ emotional distress
‐ dermatological symptoms
‐ fatigue
HIV TREATMENT
Role of Pharmacist  Prevent of medication errors: ⁻ Selecting & reviewing therapy
⁻ Clarifying medication or dosing changes
 Prevent development of resistance
 Improve adherence
 Manage drug interactions
 Monitor response to therapy
Role of the Pharmacist in Caring for Patients with HIV/AIDS: Clinical Practice Guidelines. Tseng A, Foisy M, et al. Can J Hosp Pharm. 2012 Mar;65(2):125‐45. 4
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HIV TREATMENT
Role of Pharmacist
PATIENT EDUCATION:  Help patients understand and develop individual HIV therapy goals.
 Educate patients about possible drug interactions or adverse effects.
 Explore solutions to distressing side effects.
 Help design interventions to enhance adherence.
Developing Regional Approaches to Training Community Pharmacists ‐ An AETC Program Coordinator's Guide
http://www.aidsetc.org/aidsetc?page=cf‐pharm‐te
Stream
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Role of Pharmacist
HIV TREATMENT
PATIENT EDUCATION:  Help patients understand and develop individual HIV therapy goals.
 Educate patients about possible drug interactions or adverse effects.
 Explore solutions to distressing side effects.
 Help design interventions to enhance adherence.
‐ Organizational tools (pill boxes, timers, alarms, bubble‐
packing)
Developing Regional Approaches to Training Community Pharmacists ‐ An AETC Program Coordinator's Guide http://www.aidsetc.org/aidsetc?page=cf‐pharm‐te
Nurses Role in Promoting Medication Adherence
 Work with client to determine best treatment options for their lifestyle and needs
 Explain importance of medication adherence
 Explore client’s values, beliefs and attitudes about treatment  Provide information on potential side effects
 Plan and enact strategies that with support medication adherence  Educate client on ART using available and appropriate learning resources
 Nurses work with clients to link to primary care provider and understand the importance of routine follow‐up (may vary by clinic)
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Scenario  Collette has presented to the outpatient clinic for her scheduled appointment. She tells her nurse the her immune system is declining and her doctor wants her to start taking HIV medication. She confides that she is terrified to start taking medication because she is fearful of the side effects. What would you do?
Nurses Role in Perinatal Guidelines
 Released in December 2015
 Provincial guidelines to present perinatal transmission of HIV
 Includes HIV information sheet, three clinical pathways, pre‐printed orders for mother, newborn discharge instructions sheet and provider contact information sheet
What a Nurse needs to know about AZT
 Medication administered to HIV positive mothers during labour (shown to decrease risk of passing the HIV virus to from mother to baby)
 Nurse responsible to reconstitute med (weight based dosing) and administer per pre‐printed orders  Provide patient with information on purpose of medication and common side effects
 AZT comes as a syrup for babies and reduces the risk of transmission of HIV to baby. Nurse will support mom by providing education and support with administration 6
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HIV Care Continuum Conclusion
 Team‐based approaches are important in HIV prevention, treatment and care
 Multidisciplinary teams are partnerships between the workforce of health professionals, including community based organizations working towards a common goal (HIV viral suppression)
 Maximization of skills and abilities of different team members  Team approach produces greater efficiency 7