How to switch to Fixed Dose Combination (FDC) in patients who are taking ART now: 1. Patients on d4T+3TC+NVP will be switched to triple FDC of same drugs to be taken one pill bid. 2. Patients on AZT+3TC+NVP will be switched to triple FDC of same drugs to be taken one pill bid. 3. Patients on d4T+3TC+EFV will be switched to double FDC of d4T+3TC and EFV. 4. Patients on ZDV+3TC+EFV will continue taking combivir and EFV. Treatment naïve patients who will be started with the updated ART guidelines will take: 1. TDF+FTC+EFV as triple FDC unless there is contraindication to this combination. For the alternative regimens see the above table.
11. Adherence 11.1. General Consideration •
High level of adherence to ART is mandatory in patients for the success of the treatment. Poor adherence results in emergence of drug resistance with implications to the individual patient and the community.
Table 12: Correlation between adherence and virologic response to ART Adherence to ART* >95% adherence 90- 95% adherence 80- 90 % adherence 70- 80 % adherence <70% adherence
•
Viral Load <400 copies/ml 78% 45% 33% 29% 18%
Multiple factors contribute to optimal treatment adherence. As ART is life long, patients might easily develop “treatment fatigue”; transport costs, lack of support, non-disclosure, drug side effects, pill burden, stigma, undiagnosed depression, poor quality service delivery set up, and substance use also contribute to poor adherence.
75