HIV Viral Suppression Toolkit


1. Introduction 

Viral suppression is the process of suppressing or reducing the function and replication of a virus. People with higher viral loads have a greater risk for immune system damage which in turn, leaves the body at risk for opportunistic infections. When discussing antiretroviral therapy (ART) for HIV, a regimen is highly successful if it reduces a person's viral load to undetectable levels (less than 50 copies/ml). The term "viral load" refers to the number of copies of HIV per mL of blood, i.e., the amount of virus in the blood. 

Achieving viral suppression by taking HIV medicines allows people living with HIV to have nearly normal lifespans and greatly reduced chances of transmitting the virus. It is now recommended that persons diagnosed with early disease are initiated on ART, and as these new guidelines are implemented, the prevalence of viral suppression should increase. Currently only 30% of all people living with HIV have achieved viral suppression. Yet, 76% of people in HIV medical care achieve viral suppression. If ART is discontinued, a person’s viral load will likely return to a detectable level. So, to achieve viral suppression, it is important to have clients take their anti-HIV medications exactly as prescribed. This is known as "treatment adherence." 

Disparities persist in the estimated rates of new HIV infections. Gay, bisexual, and other men who have sex with men (MSM) of all races and ethnicity remain the population most profoundly affected by HIV. In 2010, the rate of new HIV infections for Latino males was 2.9 times that for white males, and the rate of new infections for Latinas was 4.2 times that for white females. Young Black/African American MSM aged 13–24 are at highest risk. These groups are the most difficult to engage in care and keep in care. They are less likely to have access to resources that promote health. They are likely to live in poverty and be homeless. Besides, some may not have health insurance or coverage, which might present extra challenges for accessing and maintaining care. 

Timely linkage to care and greater frequency of care visits are associated with faster time to viral suppression with implications for individual health outcomes and for secondary prevention. These also lead to an important public health outcome - community viral load suppression. Therefore, it is important for all clinicians to be aware of their client's frequency of medical care visits, treatment adherence, and viral load. This tool kit offers clinicians several resources to assist clients in increasing their knowledge about HIV infection, transmission, the importance of consistently taking their medication according to provider directions, maintaining low to no risk behaviors, and overcoming socioeconomic barriers. Getting and keeping people in HIV medical care saves lives. Keeping HIV at a low level helps clients stay healthy and live longer, and greatly reduces the chances of passing HIV on to others.


2. Medication Adherence Tools 

Adherence Screen

Readiness to Change Assessment for Medication Adherence – This tool is not for lay persons to administer. Must know Stages of Change.

TARGET Center 
Adherence 
Information to help clients adhere to treatment regimens.

Medication Adherence Assessments 

  • Part I is a client-administered assessment tool to assess readiness to undertake antiretroviral therapy. 
  • Part II is for patients presently on medications 

Fact Sheet: Undetectable Viral Load 

Fact Sheet: CDC Vitalsigns 
HIV care saves lives – Viral suppression is Key. Website has printable and email versions 

Word on the Street: Advice on Adhering to HIV Treatment 
People living with HIV and HIV experts talk about why adherence is important and share strategies for ensuring clients remember to take their medications. Website has printable and email versions.


3. Promising and Evidence-Based Practices

Complete Listing of Medication Adherence Evidence-Based Behavioral Interventions  

Listing of All Medication Adherence Interventions, by Characteristic 

Effective Interventions – Medication Adherence: Every Dose Every Day 

  • Strategies to improve HIV medication adherence 
  • A New Medication Adherence e-learning Training Toolkit for Providers 
  • 4 Medication adherence Strategies approved for e Learning Courses 

Interactive and media rich e-Learning training on 

  • Benefits of ART adherence 
  • Components of each adherence strategy 
  • Key players, staff roles and responsibilities 
  • Overview of session content 
  • Strategy in action (e.g., videos of sessions) 
  • Integrating the strategy into practice

A Guide to CBO Adherence Programs 
Ideas for agencies setting up adherence programs/services. Features barriers to adherence and techniques for overcoming them, along with profiles of select agencies and their adherence programs.

Connecting to Care: Addressing Unmet Need in HIV 
Workbooks describe ways to help connect people living with HIV/AIDS to medical care and activities developed and implemented. 

Treatment Improvement Protocols (TIP)


4. Videos, Apps, and Web-Based Tools

HIV/AIDS: How Everyone Benefits From Undetectable Viral Load 
Suppressing the HIV virus to "undetectable" levels has long played a key role in maintaining the health of people with HIV—and recent research shows it can also dramatically cut HIV transmission risk, with implications for individuals, couples, and populations. 

Viral Load and Monitoring 
This animation describes how viral load is measured by your doctor and clinic, and what a high versus low viral load can mean over time with respect to virus reproduction and treatment. 

Adherence and Resistance Issues with HIV Drug Treatment 
This animation describes how adhering to your prescribed medication schedule is beneficial and minimizes the risk that your HIV will develop resistance to your medical treatment. 

Free HIV/AIDS Videos – Many Languages and Topics

  • HIV ANSWERS – Download from the App Store or Google Play for a mobile device. You can also see this on a computer.
    • Get answers 
    • Start treatment 
    • Talk to doctors 
    • Keep track of health information 
       
  • THE BODY – The Complete HIV/AIDS Resource – Medication and Health Reminders – Helps organize your HIV treatment information privately and securely in one place. Track your CD4 count, viral load, medications, and more. Download from the App Store or Google Play 
     
  • STOP THE VIRUS 

Web-based educational resources from Gilead


5. Strategies for Working With Clients Who Haven't Reached Viral Suppression and Reminders

Helpful handouts from CDC

HIV/AIDS Training: Greeting the Patient and Starting the Session 
Training video of basic counseling skills for lay counselors working with ARV adherence and how to start a client session. 

  • MyMeds by MyMeds, Inc. – Download from iTunes
     
  • MyMed Schedule by MedActionPlan – Medication schedule reminder program with pictures of your pills. Download from iTunes 
  • Med Helper-Pill Reminder and Medication Tracker – Keeps track of Rx, alarm reminders, alerts when meds are running low. Download from iTunes 
  • Simple Pill Tracker – Keep track and manage your pills. Download from iTunes

6. Medical Coordination

NYC Health: The New York City Department of Health and Mental Hygiene 
Website contains tools, and educational materials for HIV-related health care and care coordination for HIV-infected persons. 
Spanish and English.

County of Los Angeles Public Health: Division of HIV and STD Programs 
Resources for Medical Care Coordination