World AIDS Day

The acquisition of the human immunodeficiency virus (HIV), which attacks and destroys the infection-fighting CD4 cells of one’s immune system.¹ The loss of these cells makes it increasingly challenging for one’s body to fight off other infections, illnesses, cancers, and so on.¹ Without treatment, the HIV infection progressively worsens over time, destroying one’s immune system. ²

Stages of HIV 

1. Acute HIV Infection
   1. Develops 2-4 weeks after the infection with HIV.²
      1. Marked by flu-like symptoms.²
      2. HIV multiplies rapidly and spreads throughout the body, attacking and destroying the infection fighting CD4 tells. During this acute state of infection, blood levels of HIV are at their peak, dramatically increasing the risk of potential HIV transmission.²
2. Chronic HIV Infection
   1. People in this stage may not have any symptoms.² 
   2. HIV multiplication slows, but continues to multiple at low levels.²
   3. Without ART treatment (antiretroviral therapy), chronic HIV infection advances to AIDS within 10+ years.²
3. Acquired Immunodeficiency Syndrome (AIDS)²
   1. The most severe stage of HIV infection, causing severe damage to the immune system. 
   2. The body becomes unable to fight off opportunistic infections, which may also be referred to as “AIDS-defining conditions.”²
   3. Diagnostic criteria: CD4 count below 200 cells/mm³.² Once HIV progresses to the AIDS stage, a person’s viral load is high and transmission rates increase.² 
   4. Without ART treatment, people with AIDS survive 3 years on average.²

HIV Stigma

HIV stigma refers to the negative attitudes and beliefs about people living with HIV.³ The stigma associated with HIV can discourage people from seeking testing, sharing their status with others, and accessing HIV services, such as ART treatment.³

Examples of HIV Stigma: 

1. The belief that only certain groups of people can get HIV. 
2. Judging people who take steps to prevent getting HIV (such as PrEP). 
3. Feeling people deserve to get HIV because of their sexual choices. 

HIV Discrimination

HIV discrimination is the behavior that results from the attitudes and beliefs related to HIV stigma.³ Discrimination against people living with HIV results in people treating those with HIV differently than those living without HIV.³

Examples of HIV Discrimination: 

1. Refusing to provide health services to an individual with HIV. 
2. Refusing casual contact, such as shaking hands or hugging, with someone with HIV. 
3. Isolating a member of a community because they have HIV. 
4. Asking if someone is “clean,” or referring to them as “dirty” if they have HIV. 
5. Assuming someone has HIV because of their identity and behaviors. 

The Importance of Medication Adherence and Reasons for Non-Adherence

When taken consistently, Antiretroviral Therapy (ART), enables individuals living with HIV to live long, healthy lives and substantially reduces the risk of HIV transmission.⁴ However, taking HIV medicines as prescribed is vital, as they prevent HIV from multiplying, reducing the risk of HIV mutating and producing drug-resistant HIV.⁴

The consequences of missing or skipping a dose can allow HIV multiplication, increasing the risk of HIV drug resistance, treatment failure, and transmission to others.⁴ Furthermore, poor adherence also increases the risk of HIV destroying the immune system, which can make it exceedingly challenging for the body to fight off infections and cancers, leading to additional, potentially deadly, complications.⁴

As a result, failure to follow the prescribed ART regimen can lead to disease progression, poorer health outcomes, and increased healthcare costs.⁵ Moreover, non-adherence also poses a public health risk, as there is an increased risk of disease transmission due to the potential for developing drug resistance and/or viral non-suppression.⁵

Despite the dire risk of not following the prescribed regimen(s) for HIV treatment, numerous barriers prevent optimal adherence. A systematic review of patient-reported barriers to adherence across 125 studies including 17,061 adults found that forgetting, being away from home, and changes in daily routine were the most frequently reported barriers.⁶ 

Singular Tablet Dosing Regimens: A Key Mechanism for Enhancing Adhernece? 

One proposed method for reducing the likelihood of these unintentional forms of non-adherence is simplification of ART regimens. A randomized controlled ART adherence trial, including 750 participants, highlighted the benefits of such regimen simplifications.⁷ For participants with a single tablet regimen, 76.5% had adherence rates over the established 85% threshold for adherence, with 91.08% of participants having undetectable viral loads.⁷ In contrast, for those with single-dosing multi-tablet regimens, only 68.9% achieved over 85% adherence, while even fewer, 66.31% achieved such adherence levels for those with multi-dosing multi-tablet regimens (p  = 0.043).⁷ Moreover, both those in the single-dosing multi-tablet regimen and multi-dosing multi-tablet regimen groups had significantly lower rates of undetectable viral loads when compared to the single-dosing single-tablet regimen (70.67% for single-dosing multi-tablet regimen and 75.74% for the multi-dosing multi-tablet regimen, respectively).⁷ This is likely due to their lower rates of optimal (>85%) adherence, resulting in some individuals failing to achieve undetectable levels of the HIV virus, meaning that they can still transmit the virus. 

Participants on each of these regimens, with different levels of complexity, reported their reasons for nonadherence as follows:⁷

• Forgot (p < 0.001)
  • Single tablet regimen = 15.36%
  • Single-dose multi-tablet regimen = 38.57%
  • Multi-dose multi-tablet regimen = 46.08%
• Too busy (p < 0.001)
  • Single tablet regimen = 14.67%
  • Single-dose multi-tablet regimen = 37.78%
  • Multi-dose multi-tablet regimen = 47.56%
• Confusion on what to take (p < 0.02)
  • Single tablet regimen = 5.13%
  • Single-dose multi-tablet regimen = 35.90%
  • Multi-dose multi-tablet regimen = 59.97%

Patients with the simplest regimen were more likely to adhere to their ART regimen than those on a single-dose multi-tablet regimen or multi-dose multi-tablet regimen.⁷ Logically, once-daily single-tablet dosing minimizes opportunities for error: there is less likelihood of forgetting the dose entirely, fewer tablets to track, and far less cognitive burden associated with remembering what to take and when. The sharp escalation in reported rates of “forgetting,” “being too busy,” and “confused about what to take” as dosing regimens increase in complexity reinforces this.

While this indicates the benefits of regimen simplification in enhancing medication adherence, it is important to note that single, once-daily dosing cannot entirely eliminate non-adherence. Across various studies, even for patients on the simplest ART regimen, non-adherence still remains at an estimated 20-25%.⁷ Even for patients with simplified dosing regimens, the need to consistently remember to take medication, even once, on a daily basis can be overwhelming.⁸ 

The Prevalence of Medical v. Non-Medical Reasons for Non-Adherence 

Interestingly, in a global sample of 2389 participants, of the 575 reporting suboptimal adherence (24.1 of the overall sample), 83.5% reported nonmedical reasons for nonadherence, such as being away from home/travelling, feeling uncomfortable taking their medication in public, simply forgetting to take their medication, running out of their medication, wishing to forget about their HIV diagnosis, or difficulty accessing treatment due to cost.⁸ In contrast, 20% fewer respondents reported medical reasons for nonadherence such as difficulty swallowing their medications, side effects, and drug-food interactions.⁸ This suggests that unintentional, situational, and/or psychosocial factors are the primary drivers of nonadherence among patients living with HIV, as opposed to purely medical barriers.

Interventions which exclusively focus on managing side effects or medical challenges may miss the majority of population-specific barriers to optimal adherence. Addressing these nonmedical barriers, such as through regimen simplification, reminder systems, discreet packaging, patient education, and behavioral support, may have a greater impact on improved adherence, and subsequently, health outcomes. The opportunity for patients to provide context surrounding their reasons for non-adherence may be exceedingly beneficial as this enables clinicians and researchers to tailor interventions accordingly.⁸

Methods for Addressing Medical-Related Reasons for Non-Adherence

Pill Aversion

Across the general population, estimates suggest that up to 40% of adults struggle with pill aversion, defined as a difficulty swallowing pills without an identifiable medical cause.^{9, 10} Despite the prevalence of pill aversion, assessment for it is not a part of the United States national guidelines or a standard of care.⁹

Notably, HIV medications become less effective if they are not taken consistently, which can lead to viral resistance, necessitating an increased pill burden and/or fewer choices for effective medications to prevent HIV from progressing to the AIDS stage.⁴ For those with a chronic aversion to pills, this behavioral issue is likely to intensify with time, suggesting the need for alternative methods of medication administration.⁹

For individuals with pill aversion, antiretroviral therapy can be delivered through alternative formulations such as liquid suspensions, crushable tablets, or powders that can be mixed with food or beverages.¹¹ In some cases, healthcare providers may recommend long-acting injectable formulations,¹¹ which are administered intramuscularly once monthly or less frequently, reducing the need for daily pill-taking. These options may enhance adherence, helping to maintain optimal drug levels and reduce the risk of viral resistance. 

Side Effects 

While newer ART regimens have been associated with less serious and/or intolerable adverse effects, up to 10% of participants enrolling in randomized trials for novel medications still experience these effects.¹² These effects can include adverse cardiovascular, dermatological, gastrointestinal, hepatic, hypersensitivities, metabolic, musculoskeletal, neuropsychiatric, and renal effects.¹² Notably, comorbid conditions, drug-drug interactions, and dosing errors may all predispose individuals living with HIV to such adverse effects.¹²

Timely communication with providers about side effects is critical for ensuring patient safety, adherence, and treatment optimization. Immediate reporting of adverse effects allows clinicians to intervene quickly, adjust or change regimens if needed, and provide guidance to mitigate complications which may include pharmacological or non-pharmacological interventions.¹² AdhereTech’s Aidia System enables patients to report side effects in real time via SMS messaging, ensuring that providers receive timely, actionable information. This immediate feedback loop not only allows for safer, more personalized care but also strengthens patient-provider communication, fostering adherence and improving long-term treatment outcomes.

Drug-Food Interactions 

A recent systematic review assessing 33 antiretroviral medications found that more than half exhibit clinically significant interactions with food.¹³ For several commonly prescribed agents, including tenofovir disoproxil, etravirine, rilpivirine, dolutegravir, elvitegravir, and multiple protease inhibitors, taking the medication with or immediately after a meal is essential to ensure adequate absorption and therapeutic drug levels. In contrast, other medications like didanosine, zidovudine, efavirenz, and indinavir require administration on an empty stomach to maximize benefit and prevent reduced efficacy.¹³ Ensuring patients under these distinctions in dosing is critical, as even consistent medication-taking behaviors may not compensate for suboptimal drug absorption caused by an incorrect dosing time.¹³  

Drug-food interactions are an often overlooked factor of variability in treatment response, even when patients are otherwise highly adherent to their medications.¹³ Speaking with providers to clarify dosing requirements is essential for ensuring patients not only understand how to take their ART medications, but when to take their medications as well.¹³ Clear, personalized guidance can help to minimize preventable adherence challenges and ensure consistent, effective drug exposure that maintains viral suppression.¹³

AdhereTech’s devices allow for customizable dosing windows, helping patients align their medication-taking behaviors with the specific food-related requirements of their regimen. For instance, consider a patient who does not eat until 12pm. If their ART medication requires food intake prior to dosing, a dosing window after 12pm can be set. Vice versa, if their ART regimen requires no food intake prior to ingestion, a dosing window prior to 12pm can be scheduled. Additionally, AdhereTech’s SMS tailored messaging also has the capability to provide additional reminders instructions regarding drug-food interactions, which can provide patients with a gentle reminder of their dosing instructions. 

By reinforcing the correct timing, whether a drug must be taken with a meal or on an empty stomach, these tools can reduce preventable variability in drug exposure that stems from misunderstood instructions. This tailored support ensures patients receive real-time guidance that complements their clinical care, ultimately helping sustain therapeutic drug levels and long-term viral suppression.

Circadian Rhythm Challenges 

Sleep difficulties are common among patients living with HIV/AIDS, with about 70% of individuals reporting issues such as insomnia, daytime fatigue, and fragmented sleep.¹⁴ Notably, the HIV trans-activator of transcription (Tat) protein, released from HIV-infected glial cells and macrophages in the brain, directly affects the brain’s master circadian clock in the suprachiasmatic nucleus (SCN), contributing to circadian rhythm disturbances.¹⁴ These disruptions may occur because Tat activates N-methyl-D-aspartate (NMDA) receptors and interferes with the brain’s light-entrainment pathway.¹⁴ Light entrainment is the process by which the brain’s internal clock adjusts to the external environment’s light–dark cycle, helping synchronize sleep and wake patterns to the environment.¹⁴

One study including 96 patients living with HIV/AIDS, found that the HIV Tat protein disrupts the body’s circadian rhythms, as indicated by reduced daily fluctuations in their blood pressures and heart rates.¹⁴ Surprisingly, higher Tat levels were also linked to increased melatonin secretion, which may help improve sleep despite circadian disruption¹⁴. This suggests that although increased concentrations of Tat impair the internal clock, the resulting rise in melatonin could partially offset HIV-related sleep problems, providing a theoretical explanation for why sleep quality may not always worsen as HIV progresses. 

To help patients with HIV/AIDs overcome these circadian rhythm disruptions and support adequate adherence, interventions should focus on stabilizing sleep-wake patterns, fostering daily and night-time routines.^{15, 16} Strategies such as a consistent sleep schedule, controlling exposure to natural light during the day, limiting exposure to artificial light in the evening, and timing medication appropriately (ex: with meals, at night, in the morning, etc.) may all help to reinforce the circadian clock.^{15, 16} Improved sleep quality may reduce daytime fatigue and cognitive challenges, which are known barriers to taking medications consistently.²⁰ Additionally, leveraging adherence-support tools, such as smart technologies with reminders, can compensate for the effects of disrupted circadian rhythms, ensuring patients maintain their treatment regimens despite sleep disturbances.

How AdhereTech Prevents Non-Medical Barriers to Non-Adherence 

Being away from home or traveling

Even highly adherent patients can miss doses when their routines are disrupted by work travel, vacations, or unexpected changes in their daily schedule.^{6, 8} Humans rely heavily on habitual patterns, and when these routines are disrupted, even slightly, cognitive load and mental fatigue can increase, ¹⁷ making it easier to unintentionally skip doses. 

AdhereTech helps to mitigate the likelihood of this by providing recurring reminders that continue regardless of location. If a patient brings their device with them while traveling, the smart devices functionality over the 4G network ensures that doses are prompted via visual and audible cues for reliability, helping maintain adherence even outside of a regular routine. Moreover, the recurring SMS reminders allow for patients to report reasons for non-adherence, allowing clinicians insight into adherence challenges that enables them to develop tailored interventions to prevent busy or fluctuating schedules from interfering with patients’ medication-taking behaviors. 

For longer trips or anticipated trips, patients can contact AdhereTech’s care team, who can coordinate dosing time changes to accommodate changes in time zones or schedule. By combining consistent reminders with proactive support, AdhereTech helps prevent missed doses during travel or other schedule disruptions.

Feeling uncomfortable taking medication in public

Some patients may be hesitant to take their HIV medications in front of others due to privacy concerns or stigma associated with their HIV diagnosis. AdhereTech minimizes the need for public pill-taking by allowing patients to plan dosing within flexible, personalized windows. Furthermore, the smart bottles discreet design eliminates prescription labels and medication information that appears on a regular pill bottle, adding an additional layer of confidentiality for patients. 

Moreover, the ability for customizable reminders, such as only enabling text or call reminders, allows patients to receive medication adherence support while maintaining their privacy. 

Simply forgetting to take their medication

Forgetfulness is one of the most common non-medical drivers of non-adherence.^{6, 8} Memory lapses, where information is stored but not readily retrievable, are a normal part of daily life for all individuals.¹⁸ AdhereTech helps patients overcome this challenge by delivering real-time reminders that escalate if a dose is missed. These repeated nudges prevent unintentional missed doses via an escalation protocol: a gentle glow emitting from the device before dosing window, the device emitting a chime every 15 minutes within a patient’s dosing window, and an SMS or call-based reminder if a dose is missed. 

These sequential reminders help to prevent forgetfulness, serving as a gentle reminder to support patients in taking their medications while simultaneously supporting the formation of consistent medication-taking habits.  Research suggests that establishing a new behavior typically takes an estimated 66 days of regular practice before it becomes habitual. By providing reliable, recurring reminders, AdhereTech reinforces daily adherence until taking medication becomes an automatic, ingrained part of a patient’s routine, reducing cognitive load and supporting long-term treatment success. 

Running out of Medication

Running out of medication can derail adherence, even when patients are otherwise fully adherent to their prescribed dosing regimen. Notably, individual, interpersonal, and system-level barriers can complicate the refill process making it challenging for individuals to get a refill within a timely manner, leading to gaps in care.¹⁹ Individuals report transportation challenges, difficulty getting to the pharmacy within operating hours due to work schedules, long travel times to pharmacies, forgetting to call in for non-automated refills, and anxiety and/or stigma regarding having to pick up their medication at public pharmacies.¹⁹ In relation to interpersonal and systemic barriers, patients living with HIV report a lack of helpfulness from pharmacy staff, including unwillingness to account for dosing time when prescribing refills, and frustration with the refill process, such as medications not being filled in a timely manner and having to return to the pharmacy on numerous occasions.¹⁹

AdhereTech’s Aidia System monitors patients’ dosing patterns, and with the smart bottles electronic field capabilities can detect when medication is running low, alerting care teams or pharmacy partners that a patient is nearing the end of their supply. This proactive coordination can help to ensure refills are requested and delivered on time, preventing gaps in treatment caused by preventable logistical challenges. 

Wishing to forget about their HIV diagnosis

Despite public efforts to reduce the stigma associated with living with an HIV diagnosis, stigma is still prevalent. For some individuals, skipping medication may reflect a desire to momentarily distance themselves from these negative feelings.  Motivational text messages can encourage adherence without adding pressure, reframing medication-taking as an empowering, self-directed act rather than a constant reminder of illness. Moreover, real-time adherence tracking allows care teams to identify potential gaps and intervene supportively when needed, reducing the cognitive and emotional burden of managing treatment and helping patients stay on track even during periods of stress or fatigue.

Cost-Related Nonadherence 

Notably, recent reports suggest the prevalence of cost-related nonadherence for individuals living with HIV is an estimated 7%.⁸ With an approximate 1.2 million people living with HIV in the United States, this suggests that 84,000 individuals struggle to stay on treatment due to the financial burden associated with accessing ART.

When a dose is missed, AdhereTech empowers patients to share why, including whether the lapse was driven by medication cost or insurance barriers. This real-time insight allows AdhereTech’s technical support team to connect patients with low-cost or affordable assistance programs, helping prevent interruptions in ART access.

Additionally, these insights enable healthcare professionals to intervene proactively, ensuring that financial challenges do not escalate into treatment failure. By bringing visibility to cost-related barriers and offering immediate pathways to support, AdhereTech helps ensure that patients can maintain access to consistent, uninterrupted care.

AdhereTech: Supporting Patients Living with HIV 

World AIDS Day serves as a critical reminder of the ongoing challenges faced by people living with HIV, the importance of early diagnosis, and the life-saving impact of consistent antiretroviral therapy (ART). Despite remarkable advances in treatment, barriers (both medical and non-medical) continue to undermine optimal medication adherence, threatening individual health and public safety. Simplified ART regimens, alternative medication formulations, and innovative tools such as AdhereTech’s Aidia System demonstrate how tailored interventions can address these barriers, supporting patients in overcoming forgetfulness, stigma, travel disruptions, and treatment complexity. More importantly, by improving adherence, Aidia supports patients in achieving undetectable viral loads, which in turn, prevents virus progression, reduces the risk of transmission, prevents immune system degradation and in turn minimizes the risk of additional complications, and enhances long-term health outcomes. 

By combining behavioral insights, technological support, and personalized care, we can help people living with HIV maintain viral suppression, prevent disease progression, and reduce transmission. World AIDS Day reminds us that the fight against HIV is not only a medical challenge but also a social and behavioral one – and that sustained progress depends on compassion, innovation, and equitable access to care for all.

References

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² National Institutes of Health. (2025, March 31). The stages of HIV infection. HIVinfo. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/stages-hiv-infection 

³ Centers for Disease Control and Prevention. (2024, April 16). Health Equity in HIV. CDC. https://www.cdc.gov/hiv/health-equity/index.html

⁴ National Institutes of Health. (2025, January 13). HIV treatment adherence. HIVinfo. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-treatment-adherence 

⁵ World Health Organization. (2025). WHO guideline on HIV service delivery: updated guidance on the integration of diabetes, hypertension and mental health services, and interventions to support adherence to antiretroviral therapy (ISBN 9789240113879). World Health Organization. https://iris.who.int/handle/10665/382521 

⁶ Shubber, Z., Mills, E. J., Nachega, J. B., Vreeman, R., Freitas, M., Bock, P., … & Ford, N. (2016). Patient-reported barriers to adherence to antiretroviral therapy: a systematic review and meta-analysis. PLoS medicine, 13(11), e1002183. 

⁷ Chen, Y., Chen, K., & Kalichman, S. C. (2017). Barriers to HIV Medication Adherence as a Function of Regimen Simplification. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 51(1), 67–78. https://doi.org/10.1007/s12160-016-9827-3 

⁸ de Los Rios, P., Okoli, C., Punekar, Y., Allan, B., Muchenje, M., Castellanos, E., … & Van de Velde, N. (2020). Prevalence, determinants, and impact of suboptimal adherence to HIV medication in 25 countries. Preventive Medicine, 139, 106182. 

⁹ Dorman, R. M., Sutton, S. H., & Yee, L. M. (2019). Understanding HIV-Related Pill Aversion as a Distinct Barrier to Medication Adherence. Behavioral medicine, 45(4), 294–303. https://doi.org/10.1080/08964289.2018.1534076

¹⁰ McCloskey, A. P., Penson, P. E., Tse, Y., Abdelhafiz, M. A., Ahmed, S. N., & Lim, E. J. (2022). Identifying and addressing pill aversion in adults without physiological-related dysphagia: A narrative review. British journal of clinical pharmacology, 88(12), 5128–5148. https://doi.org/10.1111/bcp.15463

¹¹ Northwestern Medicine Antimicrobial and Diagnostic Stewardship Program. (2021, January 11). Antiretroviral crush / do not crush list. https://adsp.nm.org/uploads/1/4/3/0/143064172/crush_hiv_table_1.14.21.pdf 

¹² National Institutes of Health. (2025, September 25). Adverse Effects to Antiretroviral medications: Limitations to treatment safety and efficacy. HIVinfo. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/adverse-effects-antiretroviral-agents 

¹³ Wiesner, A., Skrońska, M., Gawlik, G., Marcinkowska, M., Zagrodzki, P., & Paśko, P. (2023). Interactions of Antiretroviral Drugs with Food, Beverages, Dietary Supplements, and Alcohol: A Systematic Review and Meta-analyses. AIDS and behavior, 27(5), 1441–1468. https://doi.org/10.1007/s10461-022-03880-6 

¹⁴ Wang, T., Jiang, Z., Hou, W., Li, Z., Cheng, S., Green, L. A., Wang, Y., Wen, X., Cai, L., Clauss, M., & Wang, Z. (2014). HIV Tat protein affects circadian rhythmicity by interfering with the circadian system. HIV medicine, 15(9), 565–570. https://doi.org/10.1111/hiv.12154 

¹⁵ Webel, A. R., Moore, S. M., Hanson, J. E., Patel, S. R., Schmotzer, B., & Salata, R. A. (2013). Improving sleep hygiene behavior in adults living with HIV/AIDS: a randomized control pilot study of the SystemCHANGE(TM)-HIV intervention. Applied nursing research : ANR, 26(2), 85–91. https://doi.org/10.1016/j.apnr.2012.10.002 

¹⁶ Song, S., Muneer, M., Tahir, Z., Garrison, K. A., & Ziskind, S. (n.d.). Circadian-based sleep interventions in clinical applications: A narrative review. SleepSanity, LLC. DOI: 10.20944/preprints202511.2169.v1 

¹⁷ Berg, S. (2025). What doctors wish patients knew about decision fatigue. American Medical Association. https://www.ama-assn.org/public-health/behavioral-health/what-doctors-wish-patients-knew-about-decision-fatigue 

¹⁸ Cherry, K. (2025, May 1). The psychology of forgetting and why memory is far from perfect. VeryWell Mind. https://www.verywellmind.com/forgetting-about-psychology-2795034 

¹⁹ Johnson, S. R., Giordano, T. P., Markham, C., Njue-Marendes, S., & Dang, B. N. (2020). Patients’ Experiences with Refilling their HIV Medicines: Facilitators and Barriers to On-Time Refills. The Permanente journal, 24, 1–3. https://doi.org/10.7812/TPP/19.207 

²⁰ Amato, L., Giannetta, N., Taborri, S., Dionisi, S., Panattoni, N., Di Simone, E., De Leo, A., Liquori, G., Orsi, G. B., Fabbian, F., & Di Muzio, M. (2024). Sleep Quality and Medication Adherence in Older Adults: A Systematic Review. Clocks & sleep, 6(3), 488–498. https://doi.org/10.3390/clockssleep6030032