Introduction
Acquired immune deficiency syndrome (AIDS) is an extremely devastating disease which presents as a key issue in world health in recent times. AIDS is not curable yet, but it is preventable and increasingly treatable with modern medicine. With adherence to appropriate pharmacotherapy, progression of the infection to AIDS could be reasonably delayed (Hogg, Health, Yip, et aI., I998; Mocroft, Ledergerber, Katlama., Konopnicki, De-Wit, & Antunes, 2003). Antiretroviral medicines (ARV) and use of combinations of these medicines increase the life expectancy of people living with HIV/AIDS (PLWHA). Combination therapy defends against viral resistance to medication but there are possibilities of pill burden and serious side effects as a result of large dosing schedules (Saitoh, Hull, Franklin, & Spector, 2005). Despite the burden associated with multiple medications, adherence to ARV regimen is pivotal to preventing development of mutant strains of the virus. AR)/s delay progression of HIV infection thus transforming the disease into a treatable but chronic condition; however the need to continue treatment for decades rather than months calls for a long term perspective on antiretroviral
therapy (ART). Adherence is a major determinant of the success of ART (Coopman, 2002; Paterson, Swindells, Mohn, Brester, Vergis, Squire, Wagener et al., 2000) and generally, adherence to a medication regimen is defined as, ‘the extent to which patients take medications as prescribed by their health care providers’ (Osterberg
& Blaschke, 2005). Studies have shown that long term viral suppression requires near perfect adherence (Bangberg, Perry, Charlebois, Clark, Roberston, Zolopa et al., 2001) and up to 95% adherence to ARV is required to suppress viral replication and to avoid the emergence of resistant strain_s (lckovics, Cameron, Zackin, Bassett, Chesney, Johnson, et al., 2002). It has been demonstrated that a 10% higher level of adherence results in a 21% reduction of disease progression (Nischal, Khopkar, & Saple, 2005).