What Works for Women and Girls

“I started HIV medication in 2006.My husband does not know…Hebeats me up and locks me out ofthe house…I sleep under the treeuntil tomorrow. As a result of that,I miss doses sometimes.”—HIV-positive woman, Zambia(Human Rights Watch, 2007: 1)Have patients received proper information on medicationsand dosage? (Gruskin et al., 2007c). Adherence is definedas “taking medication as prescribed, and therefore issuessuch as pharmacy stock-outs are out of the patient’s control”(Bangsberg, 2008). Programs should also promote treatmentliteracy so that all people know that AIDS cannotbe cured but that ARV treatment can prolong life, withimproved quality of life (UNAIDS, 2005). For those onARV therapy, treatment literacy is vital to understandingthe importance of adherence.Improving Treatment Adherence Requires Counseling, Empowerment to OvercomeBarriersWhile there is little data demonstrating what works specifically for women in improving treatmentadherence, there are some interventions that have been shown to work for both men andwomen such as provision of counseling, including treatment support and literacy. A meta-analysisof 19 randomized controlled trials including 1,839 patients found that patients given oneon-onecounseling by health providers, with a median of two sessions lasting 60 minutes each,resulted in patients being more than one and a half times more likely to achieve 95% adherence,compared to controls (Simoni et al., 2006 cited in Vergidis et al., 2009). An observationstudy of low-literacy and low-income patients in 2005 in Mozambique also found improvedadherence among patients who received counseling from health care providers (Magnano SanLio et al., 2009). Counseling support by HIV-positive peers has been found to also be effectivein improving treatment adherence in Thailand, through a model developed by the ThaiNetwork of People With HIV/AIDS (TNP+), and in Haiti, Rwanda and Lesotho, supported byPartners in Health’s “accompaniment” model, which includes daily home visits by communityhealth workers, free clinic visits, nutritional support, transportation to clinics and preferentialhiring of HIV-positive people (Ford et al., 2009a; Mukherjee et al., 2008b). [See also Chapter11G. Strengthening the Enabling Environment: Promoting Women’s Leadership]Pill counts and pillbox organizers are low-technology empowerment tools that can increaseadherence (Jean Jacques et al., 2008). Data obtained from an observational cohort of 245 peopleliving with HIV from 1996 to 2000 in the United States showed that pillbox organizers wereestimated to improve adherence by 4.1 to 4.5% and was associated with a decrease in viral loadof .34–.37 log 10copies/mL and a 14.2% to 15.7% higher probability of achieving a viral load ofgreater than 400 copies/mL, with statistically significant effects. “Pillbox organizers should bea standard intervention to improve adherence to antiretroviral therapy” (Peterson et al., 2007).Mobile phones are promising tool that may facilitate adherence. In a study in Kenya of322 ARV patients, of whom 81% owned a mobile phone, found that nearly 88% of those whoowned a mobile phone said they would be comfortable receiving reminders and assistancewith side effects by phone (Lester et al., 2008).174 CHAPTER 7 TREATMENT