In a patient on antiretroviral therapy with a rising viral load, missed doses are a more common cause than a resistant virus. Ask about barriers first: cost of transport, stigma, food insecurity, mental health, stock-outs, and whether the person understands the regimen.
Check the drug-resistance position and adherence before changing regimen, and offer adherence support at the same visit.
- Ask what makes taking tablets difficult, in a non-judgemental way.
- Look at pharmacy refill dates, not only self-report.
- Repeat the viral load after enhanced adherence support.
- Request resistance testing before changing regimen when the viral load stays raised.
- Involve the counsellor or peer supporter, not only the prescriber.
Why it matters
Switching drugs for a problem that is really about access or support rarely fixes it.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for top clinical updates, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free