In Papua New Guinea, I have 5 drugs that are available for ART (ZDV, 3TC, NVP, EFV, TDF). If patients quit taking their medicines, or don't respond to the regimen they are on, I don't have much else to offer. We have no ability to do resistance testing, we can't even do a viral load, CD4 is all we have. We stress adherence and try and ensure that patients understand the importance of taking their ARTs before we initiate treatment. Despite this effort, patients still default - due to lack of transport, fights at their place so they can't travel, being too sick to take meds, just deciding they don't want to, being upset with their wife/husband and many more. We do counseling again and educate them on adherence as we start them again, but at times they still default again.
Any recommendations for better adherence or for options of when they do default, repeatedly with only limited medicines?