Disease Management and Health Outcomes

, Volume 10, Issue 2, pp 85–91

Clinical and Economic Implications of Non-Adherence to HAART in HIV Infection

  • Alissa Scalera
  • Ahmed M. Bayoumi
  • Paul Oh
  • Nancy Risebrough
  • Neil Shear
  • Alice Lin-in Tseng
Leading Article

DOI: 10.2165/00115677-200210020-00003

Cite this article as:
Scalera, A., Bayoumi, A.M., Oh, P. et al. Dis-Manage-Health-Outcomes (2002) 10: 85. doi:10.2165/00115677-200210020-00003

Abstract

Highly active antiretroviral therapy (HAART) has dramatically altered the natural history of HIV disease. Studies demonstrate that ≥95% adherence is necessary to garner the full benefits of HAART. However, appropriate adherence to treatment is difficult and challenging. This paper provides an overview of potential clinical and economic outcomes associated with poor adherence to HAART. Since there are no studies exploring the costs associated with poor adherence to HAART, we discuss potential direct and indirect costs accrued with more frequent treatment failures, selection of resistant strains, increased hospitalizations and a faster progression to AIDS associated with poor adherence to HAART. Additionally, we review studies of interventions and strategies to improve adherence to HAART. Although, single-focus interventions have enhanced the chances of achieving viral suppression by 10 to 23%, the literature has demonstrated that for long-term treatments, programs employing diverse interventions that continue over time are more effective. Under constrained healthcare budgets, government, healthcare managers and policy makers require accurate and timely information concerning the cost effectiveness of adherence intervention programs. We discuss considerations in determining the cost effectiveness of an adherence intervention program.

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  • Alissa Scalera
    • 1
    • 2
    • 3
    • 9
  • Ahmed M. Bayoumi
    • 3
    • 4
    • 5
  • Paul Oh
    • 6
  • Nancy Risebrough
    • 6
  • Neil Shear
    • 2
  • Alice Lin-in Tseng
    • 7
    • 8
  1. 1.Neurobehavioral Research, Mental Health ServiceSt Michael’s HospitalTorontoCanada
  2. 2.Department of Pharmacology, Faculty of MedicineUniversity of TorontoTorontoCanada
  3. 3.Inner City Health Research UnitSt. Michael’s HospitalTorontoCanada
  4. 4.Department of Medicine, Faculty of MedicineUniversity of TorontoTorontoCanada
  5. 5.Ontario HIV Treatment NetworkTorontoCanada
  6. 6.HOPE Research CentreSunnybrook and Women’s College Health Science CenterTorontoCanada
  7. 7.Immunodeficiency ClinicToronto General HospitalTorontoCanada
  8. 8.Faculty of PharmacyUniversity of TorontoTorontoCanada
  9. 9.Department of PharmacologyUniversity of TorontoCanada