Further development and evaluation of an individualized intervention for increasing adherence to HIV medications.

摘要

Highly active antiretroviral therapy (HAART) has produced substantial improvements in health outcomes for HIV patients across a number of clinical trials. However, many HIV patients do not adhere sufficiently to this treatment, thereby greatly limiting its effectiveness. Efforts to increase patients' adherence to HAART have generally produced limited effects. The purpose of this study was to further develop and evaluate the Prescriptive Adherence Counseling and Education (PACE) intervention, an individualized assessment-based intervention for increasing patients' adherence to HAART. Fifty-four HIV patients with identified poor adherence to HAART were randomly assigned to either, (1) treatment as usual (TAU), or (2) or treatment as usual plus the PACE intervention (PACE). At baseline and at 4-, 12-, and 20-week follow-ups, all participants were assessed for (1) adherence to HAART (self-report and pill-counts), (2) status on a number of adherence-related psychosocial variables (i.e. treatment/health beliefs, adherence self-efficacy, social support, depression, relationship with HIV/AIDS treatment providers, and the impact of specific barriers on adherence), and (3) health-related functioning, viral load, CD4 cell count, and the experiencing of medication side-effects. Additionally, patient satisfaction and follow-through with the PACE intervention adherence enhancement plans was assessed. Although the participants in the PACE intervention condition were found to have significant improvements in measures of adherence, health outcomes, and psychosocial variables, these results were not consistent across measures or time. Participants in the PACE condition tended to report high satisfaction with the intervention, but follow-though with the intervention was mixed. These results and directions for future research are discussed.