Quality of Life and Adherence to Antiretroviral Drugs

Abstract

Introduction: Antiretroviral therapy has led to a substantial reduction in HIV-associated morbidity and mortality. Efficacy of antiretroviral treatment in HIV/AIDS is showing inhibition of viral replication and reduction of viral load to a point where viral particles are undetectable in the blood of infected individuals. This has led to the realization that HIV/AIDS is a chronic illness and hence the quality of life of PLWHAneeds to be enhanced.
Purpose: The purpose of this literature review is to analyze quality of life and adherence to antiretroviral drugs.
Method: A comprehensive analysis of articles obtained from CINHAL, PUBMED, AIDSLINE, PSYCINFO, and Ohio link was conducted.
Results: Quality of life has received special attention in the last decade because it has been recognized as an outcome of health care and a determinant of disease progression. Quality of life is a complex broad ranging multidimensional concept defined in terms of individual’s subjective experiences. The definition by the WHO is more appropriate because it is culturally sensitive. Studies can be undertaken to improve the understanding of quality of life concept itself and the extent to which it is individually, socially and culturally determined. Understanding the dimensions and linkages among the dimensions of quality of life will facilitate the design of optimally effective interventions and organizational structures for quality patient care and also provide information to reveal trends, suggest linkages between practice variations and patient outcomes and identify potentially problematic patterns of care. Antiretroviral regimens are demanding and difficult, with numerous possible side effects and patients need to take the pills for indefinite periods of time. Efficacy of antiretroviral drugs in HIV/AIDS is showing inhibition of viral replication and reduction of viral load to a point where viral particles are undetectable in the blood of infected individuals. Persons with HIV/AIDS that adhere to medication for at least one year are less likely to experience AIDS related mortality. Hence adherence to antiretroviral regimens is imperative not only for the health of individual patients but also for the health of the public as a whole. Determination of medication adherence leads to development of innovative, effective interventions needed to facilitate behavior change, improve quality of life and prevent resistance to antiretroviral drugs.
Conclusion: The World Health Organization has developed a comprehensive culturally sensitive definition of quality of life. Generally, there is an agreement that quality of life should be measured subjectively from patient self reports and not from clinical assessments. However, there are very few interventions that have been developed to assist persons with HIV/AIDS improve their quality of life. Meanwhile studies on medication adherence have shown that there are three main ways of measuring medication adherence, pill count, self reports and the Medication Event Monitoring System (MEMS) cap. There is need to identify measurement suitable for different economic and cultural groups and this will enhance the development of interventions that would apply to each situation appropriately. Zambia can use the empirical evidence on quality of life and medication adherence to identify, develop and implement interventions that would enhance both adherence to antiretroviral drugs and quality of life. 

Keywords: QOL, Adherence, Antiretroviral Drugs