Patient self-management SP600125 cell line skills and courses that teach them have been associated with both improved adherence and better clinical outcomes in a number of studies

[20-22] and it may be helpful to patients to inform them of these and other psychological support options locally available, in line with the BPS/BHIVA Standards for Psychological Support for Adults Living with HIV [23]. A patient’s socio-economic status has a more direct effect on adherence and other healthcare behaviours, than clinicians realize. For instance, a US study found that poverty had a direct effect on adherence, largely due to food insufficiency [24]. A 2010 report on poverty in people with HIV in the UK found that 1-in-6 people with HIV was living in extreme poverty, in many cases due to unsettled immigration status [25]. Clinicians should be aware of patients’ socio-economic status and refer to social support where necessary. Clinicians should establish what level of involvement the patient would like and tailor their Hormones antagonist consultation style appropriately. Clinicians should also consider how to make information accessible and understandable to patients (e.g. with pictures, symbols, large print and different

languages) [1], including linguistic and cultural issues. Youth is consistently associated with lower adherence to ART, loss to follow-up and other negative healthcare behaviours [26] and some studies have found an independent association between poorer adherence and attendance and female gender [27], so information and consultation style should be age and gender appropriate for the patient. If there is a question about the patient’s capacity to make an informed decision, this should be assessed using the principles in the Mental Capacity Act 2005 [28]. Patients presenting at the clinic may be at different Olopatadine stages of readiness to take therapy [29] and clinicians’ first task is to assess their readiness, by means of open questions rather than closed, before supporting and furthering

patients’ decisions on therapy. However, if a patient presents in circumstances that necessitate starting ART immediately, for example with certain AIDS diagnoses or very low CD4 cell counts, then doctors should prescribe ART and provide support for the patient’s adherence, especially through the first few weeks. Recognizing symptoms that patients attribute to ART side effects might avoid loss of adherence and deterioration of trust in the patient–provider relationship [30, 31]. Supporting patients requires good communication not just between clinician and patient but also between all healthcare staff involved with their care, including those in their HIV services, their GP and any clinicians involved in management of co-morbid conditions. Patients should be offered copies of letters about them sent to their GP and other physicians.