Readiness, trust, and adherence: a clinical perspective

This paper examines the scientific bases for the recommendations on readiness, trust, and adherence that were contained in 5 HIV treatment guidelines.

The authors reviewed the treatment guidelines of 5 internationally recognized expert panels, and 5 review articles on readiness, trust, and adherence to determine the evidence for the guidelines' recommendations. These review articles were assessed to determine whether they contained: 1) a definition of the concept, 2) a measure that predicted outcomes, or 3) evidence that a replicable intervention altered outcomes.

There is no good definition, measure, or evidence that readiness predicts adherence. There were no interventions that improved readiness in a clinically useful way. There was no good definition or measure of trust, nor was there evidence that patient trust predicts adherence or that interventions improve trust. It is not clear whether trust is a cause or an effect of clinical outcomes. There is agreement that adherence is defined as taking medications as prescribed. Six measures of adherence were found, and several studies showed that they correlated poorly when applied to the same sample of patients. Adherence interventions have had some success but are poorly described and idiosyncratic such that it is difficult to replicate them in other settings.

Research on readiness and trust are unlikely to yield useful results. Systematic, long term research on clinician-based adherence interventions must be done. A life-long process such as adherence to antiretroviral treatment is unlikely to be understood without having a long-term study of a cohort of patients taking these medications.