Adherence to therapy is now more important than ever in HIV/AIDS care due to recent advances in HIV therapeutics. Poor adherence to antiretroviral drugs can result in the development of resistance by HIV to multiple drugs–and to whole classes of drugs. Such development of resistant HIV strains poses a potential public health danger. Large, multidisciplinary trials to determine how to effectively improve medication adherence for HIV+ patients are urgently needed. Prior to such major trials, preliminary work is needed in a number of areas: (1) successful models of adherence and barriers to adherence need to be determined; (2) information regarding antiretroviral treatment needs to be simplified so that it is easily understandable to general populations; (3) interventions that rely on multiple disciplines and that utilize the best intervention strategies from the research on patient education, behavior change, and social support need to be developed; and (4) pilot trials need to be conducted.
The purpose of this study is to pilot an adherence intervention; this would be accomplished by the following four aims of this proposed study.
- Simplify antiretroviral treatment information regarding the rationale for adherence, benefits of adherence, and risks of nonadherence, so that the material is easily comprehensible to patients and can be utilized in a treatment adherence intervention.
- Through a series of small focus groups (total N = 35) with HIV-infected individuals currently prescribed antiretroviral therapy, identify successful techniques for adherence that they have utilized, as well as barriers; and obtain feedback on the simplified treatment information.
- Utilize focus group information to finalize an adherence intervention protocol that is preliminarily designed as a 5-session, tailored behavioral, mixed format intervention co-facilitated by a cognitive-behavioral therapist and a nurse: (1) a group session in which information regarding treatment and the rationale for adherence is discussed, and behavioral strategies are reviewed; (2) an individual meeting in which the patient receives assistance in developing their personal adherence plan by tailoring behavioral strategies; (3) a group session in which progress is reinforced, barriers are discussed, and participants engage in exercises designed to help them gain a sense of control in their health care planning and role-play ways to discuss issues with their providers; (4) an individual session to modify and strengthen the patient’s personal adherence program; and (5) a group session focused on long-term adherence maintenance.
- Conduct a small pilot, randomized, controlled trial in which 50 HIV-infected patients who have been prescribed antiretroviral therapy are assigned to one of two conditions: the tailored behavioral intervention or an assessment only control group, to determine if the intervention significantly increases medication regimen adherence, with patients assessed post-intervention and at 3 and 6 month follow-ups.
Because of the the rapid development of resistance, the fact that when resistance develops drug efficacy is lost forever, and due to cross-resistance several drugs may be lost, there is an urgent need to develop effective interventions. This multidisciplinary project seeks to provide information needed for large intervention trials.