Implementation research on HIV adherence interventions: no time to wait

Two decades since the development of antiretroviral therapy (ART) for HIV, adherence remains the primary obstacle to achieving the best outcomes for patients receiving treatment.1 Indeed, despite the increased availability and affordability of potent once-daily regimens worldwide, the UNAIDS goal of 90% viral suppression has not been reached, partly because of poor adherence.2,3 Dedicated funding has generated a wave of rigorous research on developing and assessing interventions to promote ART adherence in both high-income and low-resource settings.4,5 Notably, a research synthesis project by the US Centers for Disease Control6 has identified 13 interventions that are supported by good evidence.7,8 In the Lancet Infectious Diseases, Marijn de Bruin and colleagues9 present the results of their multicentre randomised trial of an intervention to improve adherence to treatment for HIV-an outstanding addition to the scientific literature on adherence. Capitalising on advances in EDM technologies, novel mHealth devices, and other adherence assessment strategies (eg, pharmacy refills) might improve acceptability, feasibility, and affordability of the intervention. [...]although EDM data are integrated into most key intervention components, we do not know whether the assessment of daily adherence patterns (as with EDM) and the joint review of adherence during counselling sessions are essential to the intervention's effects...