Recommending an intervention model for the future improvement of HAART adherence in an HIV clinic.

摘要

In the United States (U.S.), approximately 8.3% of individuals infected with the human immunodeficiency virus (HIV) have a multi-drug-resistant strain. These strains are difficult to treat and pose a threat of spread to non-infected individuals. Drug resistance develops because patient adherence to highly active antiretroviral therapy (HAART) is less than 95%.;This qualitative, practice-based research led to the development of a logic model for the Intervention for the Improvement of HAART Adherence in a Clinic (or IIHAC). Because the IIHAC intervention program is based on findings from research conducted throughout the U.S., its utility may extend to many U.S. HIV clinics and not just to the San Antonio-based clinic where I had my practical experience in medication safety. I conducted a literature review to find factors associated with HAART adherence. Specifically, I conducted a literature review to identify factors that may be targeted by the intervention, to understand why some interventions are successful at improving adherence and, finally, to find interventions that improved HAART adherence. The search engines used for this research were PubMed, Ovid-Medline, Google, and Google Scholar. Emphasis was placed on English language articles published since 1999. IIHAC is composed largely from statistically significant findings of peer-reviewed articles. The research revealed that worse HAART adherence was associated with younger age, ethnic minorities, lower education level, low health literacy, unemployment, lower income, poor access to healthcare, Medicaid enrollment, and an avoidant coping style. Better HAART adherence was associated with perceived benefit, awareness that poor adherence leads to drug resistance, higher self-efficacy, lower stress, lower anxiety, absence of psychiatric disorders such as depression, absence of substance abuse, absence of cognitive impairment, good medication schedule accommodation, good social support, and a satisfactory provider-patient relationship. Interventions that improved HAART adherence involved cognitive behavioral therapy while also improving motivation, social support, and HIV-based education. From the information gathered in this literature review, I then developed IIHAC which is succinctly described in a Logic Model. Finally, I describe how an IIHAC evaluation process may be conducted within the clinic.