Source: Effects of a Behavioral Intervention on Antiretroviral Medication Adherence Among People Living With HIV: The Healthy Living Project Randomized Controlled Study
Johnson, Mallory O, PhD; Charlebois, Edwin PhD; Morin, Stephen F PhD; Remien, Robert H PhD; Chesney, Margaret A PhD. JAIDS Journal of Acquired Immune Deficiency Syndromes. 46(5):574-580, December 15, 2007.
The Study
The study examined the effect of a 15-session individually delivered cognitive behavioral intervention on the self-reported antiretroviral (ART) medication adherence of 204 HIV-infected patients. 3800 HIV-positive participants were randomly assigned to participate in the counseling program or not to participate in the program. Investigators focused on changes in adherence patterns among “low adherers,” that is, the 204 participants who reported at baseline taking fewer than 85% of their doses. The mean adherence of this group was between 60 to 65% and did not differ between the counseled and non-counseled group.
The Compliance Enhancement Program
The program consisted of 15 structured, individual counseling sessions, each of which explored environmental, emotional and behavioral aspects of risk-taking behavior.
According to Effects Of Adherence Support Programmes May Be Short Lived by David McLay, AidsMap, January 02, 2008, the intervention program included three Modules:
Module One (Stress, Coping and Adjustment) addressed issues surrounding quality of life, coping and building supportive social networks and was delivered during the first five months of the study.
Module Two (Safer Behaviors) addressed avoiding sexual and drug-related risk of transmission of HIV and other infections and disclosure of HIV status. Module Two was delivered during months five and ten.
Module Three (Health Behaviors) addressed access to medical care, adherence to anti-HIV treatments and participation in health care decisions. The final module was presented from months ten to 15. Participants were then followed up to month 25.
Results
[Excerpted from abstract]
Commentary
The study is not optimal. Because the population studied was the low adherence group, part of their improvement in compliance may have been simply a regression toward the mean. Further, the compliance rate was calculated from patients’ self-reporting, a methodology repeatedly shown to overreport actual adherence.
Nonetheless, the trend toward improvement in compliance while the enhancement program is ongoing and deterioration of that improvement after completion of the program does support the concept that patient compliance is a behavior requiring constant nurturing rather than a deficit requiring a one-time educational intervention.