A Nurse-Led Adherence Intervention for HIV Works and Saves Money

April 6, 2017

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Room for Improvement

MEMS-Caps bottles have been described by some researchers and patients as "bulky,"causing concern amongst some patients about their ability to carry their medication around discretely. Most of the potential participantswho  refused to enter the present study did so because of these large bottles.

However, according to the researchers, more "user-friendly" bottles that can electronically monitor and record medication use should become available for studies later this year. Such bottles should make implementation of AIMS less of a barrier for some patients.

Adherence and Getting to 90-90-90

Initiating ART soon after diagnosis has a profound personal benefit (improved health). What's more, ART also has a huge societal benefit (reduced spread of HIV). Clinical trials have found that people who take ART and who achieve and maintain an undetectable viral load do not pass on HIV to their sexual partners. These twin benefits of ART have inspired the Joint United Nations Programme on AIDS (UNAIDS) to set measureable goals to which cities, regions and countries can aspire in their quest to improve health and reduce the spread of HIV. UNAIDS encourages health authorities to try to achieve these goals, which go by the shorthand 90-90-90, by the year 2020:

  • 90% of people living with HIV are aware of their infection
  • 90% of people diagnosed with HIV are taking ART
  • 90% of people taking ART have an undetectable viral load

If all of these goals are met by 2020, 73% of HIV-positive people in a city, region or country would have an undetectable viral load, and therefore the risk of HIV transmission would be greatly reduced.

Researchers at the University of Washington in Seattle who have reviewed the Dutch research have noted that adherence "remains the primary obstacle to achieving the best outcome for patients receiving [ART]."

As countries and regions race to try to achieve the final 90 (90% of ART users will have an undetectable viral load) by 2020, programs such as AIMS could help play a pivotal role in ensuring high rates of success.


ART and Survival

B.C. researchers explore life expectancy among HIV-positive people -- CATIE News

Impressive gains in survival for older people with HIV but still less than general population -- CATIE News

What reduces survival 10 years after starting ART in North America and Europe? -- TreatmentUpdate 217

Challenges in achieving a longer life -- TreatmentUpdate 214

Longer life expectancy for HIV-positive people in North America -- TreatmentUpdate 200

Exploring factors linked to longer survival among ART users -- TreatmentUpdate 200

Long-term HIV infection and health-related quality of life -- CATIE News

Swiss researchers investigate drug use and its impact on health and survival -- CATIE News

About 90-90-90

90-90-90 -- An ambitious treatment target to help end the AIDS epidemic -- UNAIDS

Canada's progress towards global HIV testing, care and treatment goals -- CATIE News


  1. de Bruin M, Oberjé EJ, Viechtbauer W, et al. Effectiveness and cost-effectiveness of a nurse-delivered intervention to improve adherence to treatment for HIV: a pragmatic, multicentre, open-label, randomised clinical trial. Lancet Infectious Diseases. 2017; in press.
  2. Simoni JM, Aunon FM, Kemp CG, et al. Implementation research on HIV adherence interventions: no time to wait. Lancet Infectious Diseases. 2017; in press.
  3. Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. Jul 12;316(2):171-81.
  4. Daar ES, Corado K. Condomless sex with virologically suppressed HIV-infected individuals: How safe is it? JAMA. 2016 Jul 12;316(2):149-51.
  5. Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. New England Journal of Medicine. 2016 Sep 1;375(9):830-9.
  6. INSIGHT START Study Group, Lundgren JD, Babiker AG, Gordin F, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. New England Journal of Medicine. 2015 Aug 27;373(9):795-807.
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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication CATIE News. Visit CATIE's Web site to find out more about their activities, publications and services.

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