Public health consequences of screening patients for adherence to highly active antiretroviral therapy

Improvements in HIV antiretroviral therapy (ART) have been accompanied by i ncreasing recognition of the importance of adherence to treatment regimens for maximizing patient benefits while minimizing the emergence of drug-resi stant virus. Whether clinicians should screen patients for adherence and on ly administer therapy to those believed likely to adhere has not been resol ved. We first examine the implications of data drawn from a recent study re porting physicians' ability to predict whether patients will adhere to high ly active antiretroviral therapy (HAART) or not. We then extend previously developed mathematical models of ART to include screening for adherence and focus on resulting drug resistance as well as on HIV and AIDS incidence at the population level. We show that although screening for adherence is lik ely to reduce the level of drug resistance compared with a policy of treati ng all HIV patients with HAART, rates of new HIV infections and AIDS cases in the population would likely increase unless screening accuracy is extrem ely (perhaps implausibly) high.