One of the major limitations recognized in modern health care is the gap between the regimen that a clinician recommends or prescribes and that adhered to by the patient. Adherence to HIV treatment is a challenge for all individuals with the disease. While adherence to medications is proving to be of crucial importance, it is unclear what the best interventions are to improve adherence, and even less clear which of those might be most cost-effective.

Lisa Hirschhorn meets with Louis, a community educator, and Jesus as part of JSI's HIV Medication Adherence study

It's 7:30 am when I arrive at the Dimock Community Health Center in time for our daily staff meeting. My colleagues and I—physicians, nurses, counselors, and administrative staff—gather around the rectangular table in the lunch room to review the day's schedule and discuss patient cases. The Dimock Community Health Center, located in the Roxbury neighborhood of Boston, Massachusetts, serves 350 inner city, HIV-positive patients, most of whom are Hispanic, African American, or Caribbean. In addition to medical care, we provide mental health and case management services.

Today I see a variety of patients. Because of the nature of HIV, patients typically meet with their doctors every three months to check their viral load and white blood cell count and to track new developments in their health. During my visits with patients, I tend to focus on educating people about their condition and medications, and helping them manage the changes that HIV or AIDS brings to their lives.

Every day I write prescriptions. Some patients have been HIV positive for years and follow their treatment plans diligently. For others, adhering to treatment is a struggle. Some of my patients have mental health and substance abuse issues that not only compromise their health, but also complicate their treatment plans and their ability to stick to them. Others are deep in denial about their HIV status, and for that reason, their adherence can slip. As the principal investigator for the federal Special Projects of National Significance (SPNS) Study for Adherence, in which JSI is one of several national participants, I work with a team of HIV doctors to identify patients who would benefit from extra support to take their medications.

Today I see one of these patients. When we are finished, I take him down the hall to meet with JSI Staff Associate Abby Conviser, who interviews him about his medications, his overall health, and his quality of life. Later, I will examine my patient's chart to identify trends in his clinical outcomes, such as CD4 and viral load counts. For the SPNS study, we look at all the available patient data to identify patterns that will help us predict and prevent adherence problems. By participating in this study, my patient is helping us to find intervention methods that will improve and prolong the lives of people living with HIV/AIDS.

As the afternoon winds down, I sit in the office I share with Bela, another HIV doctor. We finish writing the day's notes in our patients' charts. I think about my role as an HIV doctor with some satisfaction. My job is focused on the well being of the individuals in my care, and at the same time contributes to the health of the world's population.

Read more about Improving HIV Medication Adherence: A Randomized Trial Comparing Clinic-Based Care to Clinic-Based Care Enhanced by Community/Home Care.

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