An 18-year-old woman arrives at the office to discuss the results of her tests. She was assessed one week ago for recurrent vulvovaginal discharge and stated that she was sexually active with two partners, occasionally taking oral contraception. The patient was counseled on sexually responsible behavior and tested for sexually transmitted infections. The HIV test results came back positive. She has no serious medical history, and she just uses oral contraceptives. The patient's family history is crucial since she has a mother who has schizophrenia and a paternal uncle who has alcohol use disorder and lives with them. She is noticeably disturbed after hearing her test results and the advice to begin antiretroviral medication. Which of the following is the most important intervention to promote adherence to treatment in this patient?

Question

Quizplus · Accepted Answer

Eductional Objective: This patient has been diagnosed with HIV and will require antiretroviral medication for the rest of his life. Nonadherence to antiretroviral medications is linked to an increased risk of treatment failure and drug resistance, and this patient is likely at risk due to considerable stresses (eg, family mental illness). Due to financial insecurity and frequent changes in health insurance coverage, young patients frequently have worse adherence.
Building a good therapy environment characterized by transparency and mutual trust is the first step in maximizing long-term adherence. A successful physician-patient collaboration is essential, in which the patient thinks his or her objectives and priorities are being addressed and the physician is acting in the patient's best interests. Once the therapeutic relationship is established, specific interventions to maximize adherence are likely to be more effective. Strategies with proven benefit include simplifying the drug regimen (eg, combination pills, once-daily dosing), automated reminder systems (eg, smartphone application), and frequent review of medication adverse effects.

An 18-Year-Old Woman Arrives at the Office to Discuss the Results