As well as monitoring retention, the guidelines call for monitoring of the entry process: “Within a given jurisdiction or service area, providers of testing services, local public health institutions, and medical clinics have a shared responsibility to monitor entry into HIV care.”

Specifically, they suggest that a case-management approach, as opposed to a simple referral, is the way to go.

When it comes to adherence to medication, the guidelines again suggest a personal approach.

Caregivers should routinely ask about adherence, instead of waiting until there’s a reason to suspect nonadherence. And practical measures - such as pill organizers or pharmacy refill counts - also can help.

The accuracy of a patient’s self-reported adherence can be questioned. Thomson noted, but “often people don’t even ask.”

In every practice, there should be “some systematic way to talk about adherence with the patient,” she said. Among other things, just bringing the subject up routinely helps impress its importance on patients, she added.

The guidelines panel noted the recommendations in many cases would need additional resources to be fully implemented.

Primary source: Annals of Internal Medicine
Source reference: Thompson M, et al “Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an international association of physicians in AIDS care panel” Ann Int Med 2012.