Managing HIV/AIDS Therapy in Treatment-Experienced Patients Why do patients miss their doses?
	Enlarged Version of Graphics Below	Dr. Wohlfeiler (OC): Forgetting. That's the biggest reason. But it could be forgetting for a lot of different reasons. I've got patients who have very busy work lives and they travel and they've got meetings. And they may not have a set schedule. And they'll simply forget even though they know these are important medications. Patients who travel sometimes forget to take their medications with them. And in our patient population too we have a fair number of patients who unfortunately become nonadherent due to substance abuse issues, drug use or other kind of substance use. And that can be a big reason for people missing doses. Dr. Kwakwa (OC): ...the number one factor reported in many studies across the board has been forgetting to take the medications, but I think it goes beyond that. Dr. Kwakwa (VO): I think competing subsistence needs, as we discussed earlier, I think the lack of understanding of the importance of adherence to the medication, I think a lack of belief in the medication, a lack of trust of the medication, and of the person prescribing the medicational routine behind the medication can all translate to poor adherence. Also incredibly important are mental-health issues such as depression, which all too often goes undiagnosed, and can certainly impact adherence negatively. And we discussed earlier the issue of active substance use also.   See Slide Dr. Kwakwa (OC): Another issue that is not talked about enough, I believe, is the issue of disclosure. For those patients living in settings where they may not have disclosed their diagnosis, strict adherence is very difficult. Dr. Bellos (OC): Too busy, forgot, had been out the night before, didn't take it before they went out, they were traveling, had a change in their daily routine, they were confused about the dosage directions-which is actually interesting, because it's one of the things that we've had to work through as the new dosing combinations have come out, in terms of having patients understand that, "No, you really only have to take this once a day." Sometimes people will run out of medications. One of the issues we've had-especially now that the majority of our patients are getting mail-order prescriptions-they will wait too long to submit their refill, and they may be out of the medications for a week or two before the mail-order pharmacy actually gets it to them. The other thing that we've had problems with, especially within the last year, is the whole issue of co-pays. Sometimes patients who have a limited income are unable to afford the co-pays, especially if it's a percentage of their actual drugs' cost, and I have actually had patients tell me that they have to wait until they get their next paycheck. They ran out of their medicines on Monday, and they don't get paid on Friday, so they have to wait until Friday to be able to repurchase their medicines, so there are a myriad of reasons that patients fail-or that patients neglect to take their medicines, and when you delve down and look at it, a lot of them are really psychosocial.
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