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    Phone: 737-255-4300

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HIV Viral Suppression Toolkit


HIV Viral Suppression Table of Contents

Toolkit created February 2016

Texas HIV Syndicate logo

 


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 considered to be 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. However, 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. Therefore, 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 retain in care. They are less likely to have access to resources that promote health. They are likely to live in poverty and be homeless. In addition, 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

Tools
Medication Adherence Tools Description/Purpose/Content
Screening Tools Adherence Screen (XLS)
Readiness to Change Assessment for Medication Adherence (DOC) - This tool is not for lay persons to administer. Must know Stages of Change.
TARGET Center
Stage I: HIV Readiness Assessment
Clinician assessment tool to assess client readiness to engage in HIV-related medical care, adhere to regimens and medication readiness.
TARGET Center
Adherence Follow Up Plan and Adherence
One-pager to help clients adhere to treatment regimens. Space provided to document important information for client.

Adherence Assessment Tools
Adherence Assessment Tools
Collection of assessment chart tools, in English and Spanish. Recommended tools:

  • Adherence Assessment A
  • Adherence Assessment B (checklist)
  • Adherence Assessment C (evaluation form)
Surveys

TARGET Center
HIV Knowledge Surveys
Series of one-page surveys to assess client understanding.

  • Medication Survey Page 1 only
Medication Adherence Assessments

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
Client-administered assessment tools to assist clinicians in working with clients on adherence to medication regimens.
FAQ for clients 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

Stories from PLWH on how they manage medication.

HIV InSite
Drug Dosing Toolkit. Information on dosing schedules, side effects, and tips on taking medications. List of medications by brand name and generic name.

 


3. Promising and Evidence-Based Practices

Practices
Promising and Evidence-based Practices Description/Purpose/Content
  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.
Sub-populations
• Drug resistant

 

• Newly diagnosed

 

• Racial minorities  
• Sexual minorities  
• Substance abuse Treatment Improvement Protocols (TIP)
Motivational Interviewing Empowering the Patient Webinar: Introduction to Motivational Interviewing (MI)
TARGET Center
Stages of Change Patient Readiness Scale

One-pager poses question to client, "How Ready are You for the Challenge of Taking Your HIV Medications Everyday" followed by a scale for patient to self-assess their readiness.
TARGET Center
Long-Term Medication Behavior Self-Efficacy Scale

Client self-assessment tool to determine patient's confidence in taking medications under various scenarios (e.g., at work, in public place). Tool is designed to assess likelihood of adherence to antiretroviral regimens.

4. Videos and Apps and Web-Based Tools

Tools
Videos
Apps
Web-based Tools
Description/Purpose/Content
Videos HIV: the Goal of Undetectable*
“Undetectable means there is so little HIV in your blood that it cannot be measured by a test. See how getting to undetectable can help you protect your health and the people you care about.
HIV: What’s Going on Inside Your Body*
You may look fine. You may feel fine. But the virus is working away, causing harm to the body. That is the trick HIV plays. Watch this video to see what HIV does and how treatment can help.

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
Apps

HIV ANSWERS

  • Get answers
  • Start treatment
  • Talk to doctors
  • Keep track of health information

Download from the App Store or Google Play for a mobile device. You can also see this on a computer.

Your PSH
Your Personal Sexual Health is an app that promotes safer, healthier sexual health paired with HIV/STD testing and prevention.

Download from the App Store or Google Play

THE BODY- The Complete HIV/AIDS Resource
My Health Tracker
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

Web-based STOP THE VIRUS
Web-based educational resources from Gilead

Positively!-A web-based program about HIV
This interactive education tool contains HIV self-management videos, testimonials, and animation to provide key messages about HIV.

Topics:

  • Getting Started
  • Newly HIV-Positive
  • How People Get HIV
  • HIV In the Body
  • How HIV Medication Works
  • Managing HIV
  • HIV and Real Life

Contains: Video, Self-Check, Resources

Trainings
List of HEI

 

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

Strategies
Working with clients not virally suppressed Description/Purpose
Client Handouts and Resources

Helpful handouts from CDC

Talking with clients about medical appointments

How to talk with clients about adherence

  • Pill from bottle to body
  • Empowering clients
  • Pharmaceutical website links

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.

Medication Reminders (apps)

RxmindMe Prescription/Medicine Reminder and Pill Tracker by Walgreens

Download on iTunes

Oregon Reminders
Set customized reminders (SMS, email and voice) for regular HIV testing, daily medication reminders, and prescription refill reminders.

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

Strategies
Medical Coordination Description/Purpose/Content
Case Conferencing  
Tools

 

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

  • Adherence Training Manual (DOC)
  • Readiness to Engage in HIV Care Tool (DOC)
  • Readiness to Adhere to ART (English/Spanish)  (DOC)

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    Last updated February 10, 2022