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Supporting HIV Care
Supporting Treatment and Persistence in HIV Care

Released: September 15, 2025

Jeffrey Kwong
Jeffrey Kwong, DNP, MPH, AGPCNP-BC, ACRN, FAANP, FAAN, AAHIVS
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Key Takeaways
  • Beyond medication management, nurses and nurse practitioners can play a pivotal role in advancing health equity by screening for and addressing social determinants of health that can impact patients’ ability to stay in care.

The advent of long-acting (LA) antiretroviral therapy (ART) and single-tablet regimens has greatly expanded HIV treatment options but supporting adherence to treatment and persistence in care remain critical priorities for healthcare professionals who care for people living with HIV. Nurses and nurse practitioners have always played a leading role in promoting ART adherence and supporting patients throughout their treatment journey. Now, as we strive towards virologic suppression for all people living with HIV, it is important to consider how advances in treatment and changes in healthcare access may impact adherence and retention in care. Our role as nurses and nurse practitioners must be flexible as we seek innovative ways to help our patients optimize their health.

Adherence Is More Than Taking a Medication
Many people think that adherence is focused solely on helping patients remember to take their daily pills. During the early days of the HIV epidemic, strict adherence to complex, multitablet regimens was essential to prevent drug resistance and virologic failure. However, the introduction of single-tablet regimens significantly reduced pill burden for many people. Furthermore, for those on LA injectables, adherence support has evolved to include maintaining on-time injection schedules, educating patients about protocols for missed doses, coordinating laboratory monitoring, managing medication logistics, and integrating patients into clinic workflows.

Offering Options for Those With Viremia
Prior to the introduction of LA ART, we had limited options for individuals who struggled with oral therapy. LA injectable ART has the potential to change this, but until recently, it was only recommended for people with virologic suppression. Now, we have data from several studies demonstrating the benefit of LA ART in people with viremia, offering those who may struggle with daily pills the opportunity to benefit from LA therapy as well.

To this end, clinical guidelines were recently revised to reflect the option of using LA cabotegravir + rilpivirine for people with viremia who are unable to achieve viral suppression on oral therapy due to adherence challenges, on a case-by-case basis.

The success of these regimens hinges on robust support systems and monitoring protocols to ensure continuity of care. In this context, nurses and nurse practitioners play an instrumental role. Diverse models of care delivery have emerged—some led entirely by nurses—demonstrating the leadership potential of nursing professionals in implementing LA therapy programs and promoting treatment success.

Managing Side Effects
In addition, whether a person is prescribed oral or LA agents, management of side effects is integral to adherence. Although most modern oral ART—especially integrase-based regimens—are well tolerated, educating patients about potential side effects and counseling them on strategies to mitigate some of the side effects can improve overall adherence.

With LA injectable therapy, injection-site reactions are the most common side effect. Educating patients about injection-site reactions and how to manage them with oral or topical analgesics, ice or heat packs on the injection site, or other pain management interventions is another important aspect of side effect management that can help in long-term adherence to treatment.

Access to Care
Of greater significance, access to care and certain social determinants of health (SDOH) are some of the biggest challenges people living with HIV face, both to adherence and persistence in care. As nurses and nurse practitioners, we often serve as patients’ link to the healthcare system. Guided by our professional code of ethics, nurses are uniquely positioned to advocate for patients who may be marginalized or unable to advocate for themselves.

Moreover, inherent in the philosophy of nursing, we strive to consider each person as more than the individual sitting in front of us, but as 1 part of a larger ecosystem that is influenced and subject to the intersection of social, political, structural, and cultural dynamics. As part of our assessment, identifying how SDOH such as insurance, housing, food, violence, employment issues, and residency status may impact one’s ability to remain and engage in care is crucial. Although this can seem like a daunting task, several validated SDOH screening tools are available, and evidence suggests that routine screening is an important part of primary care. Early identification of these factors can easily be done by nurses and other health team members, such as case managers.

As changes emerge in our healthcare system, ensuring continuity of care and access to healthcare professionals, medications, and support services is paramount. As nurses, we can proactively mitigate some of these barriers by prioritizing patients who are most vulnerable, leveraging alternative resources, collaborating with interprofessional teams, connecting with community-based organizations, and linking individuals to these services. Now more than ever, our role as nurses and nurse practitioners is vital to help promote the health and well-being of our patients as we continue to work towards ending the HIV epidemic.

Your Thoughts
What are some of the most common barriers to medication adherence and retention in care that you see in your practice? How do you, or nurses and nurse practitioners in your practice, strive to address these barriers? Leave a comment to join the discussion!

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