Cross-Site Evaluation as a Methodology: The Case of Antiretroviral Adherence Support Interventions

摘要

The use of combination antiretroviral therapy has dramatically reduced morbidity and mortality attributed to human immunodeficiency virus type-1 (HIV) infection and the acquired immunodeficiency syndrome (AIDS). Current literature suggests that adherence rates of 95% or better are necessary for optimal therapeutic outcomes; however, adherence is difficult to maintain. Few evaluations of adherence support programs have been conducted, and most have focused on short-term improvements in adherence. We describe our experiences and insights regarding the use of a cross-site evaluation methodology to determine the effectiveness of ART adherence support interventions implemented in 12 centers in the U.S. These adherence support interventions were targeted toward underserved populations diagnosed with HIV in the United States. We also delineate the benefits and challenges of this approach, and suggest implications for clinical practice.