Adherence? 100%!

Just back from another three-day Treatment Educator course in Surabaya, with 16 participants, all but one on antiretroviral therapy (ART).

One of the main objectives of such training is to encourage adherence to ART. With an increasing number of people living with HIV (PLHIV) in Indonesia starting ART provided free by the government (with some help from the Global Fund), this is clearly important.

In our session, we use the 'standard' slide from the 2000 Ann Intern Med study, which shows that only 80% of those with more than 95% adherence achieve an undetectable viral load. We use this to demonstrate that the aim must be to avoid missing any doses. Of course, we all know that newer non-nucleoside-based regimens are more forgiving, but why take chances?

Sometimes overseas activists criticise us for pressing for impossibly high standards, telling us that 100% is not achievable. They are wrong! An increasing number of PLHIV in Indonesia are 'celebrating' several years on ART, having missed no more than one or two doses in that time: 100% as near as dammit!

On the other side of the coin, Indonesians are natural hagglers. If we say that missing one dose a month is OK, the immediate response tends to be: 'two?' And so on. Much safer to insist on none.

So please, you 'foreign experts', don't confuse us by telling us that missing a couple of doses a month is OK. We know you're probably right, but there's method in our madness, and again, why take chances?

Babé