Seven steps to better adherence: a practical approach to promoting adherence to antiretroviral therapy.

The introduction of effective antiretroviral therapy has resulted in dramatic clinical benefits for those persons who have access to it. Adherence to such therapy has emerged as both the major determinant and the Achilles' heel of this success. Many patients have levels of adherence too low for durable virologic control. Virologic failure from suboptimal adherence diminishes the potential for long-term clinical success, leads to the emergence of drug-resistant virus, and may undermine the dramatic benefits in health parameters seen in resource-rich countries and expected in developing countries as effective antiretroviral therapy becomes more widely available. While adherence to antiretroviral therapy is regarded as the most important determinant of clinical outcomes in HIV-positive persons, most clinicians receive little guidance on practical steps to support and improve adherence. A structured, evidence-based, 7-step approach to supporting and improving antiretroviral adherence is described here. These steps can serve as a starting point or review for care providers working to support HIV-positive patients to successfully adhere to antiretroviral therapy.