Abstract
OBJECTIVE: To assess the feasibility and efficacy of two interventions for improving adherence to antiretroviral therapy regimens in HIV-infected subjects compared with a control intervention.
DESIGN: Randomized, controlled, pilot study.
SETTING: Department of Veterans Affairs HIV clinic and community-based HIV clinical trials site.
PARTICIPANTS: Fifty-five HIV-infected subjects on stable antiretroviral therapy regimens. Subjects were predominantly male (89%) and African American (69%), and had histories of heroin or cocaine use (80%).
INTERVENTIONS: Four weekly sessions of either nondirective inquiries about adherence (control group, C), cue-dose training, which consisted of the use of personalized cues for remembering particular dose times, and feedback about medication taking using Medication Event Monitoring System (MEMS) pill bottle caps, which record time of bottle opening (CD group), or cue-dose training combined with cash reinforcement for correctly timed bottle opening (CD+CR).
MEASUREMENTS: Opening of the pill bottle within 2 hours before or after a predetermined time was measured by MEMS.
RESULTS: Adherence to the medication as documented by MEMS was significantly enhanced during the 4-week training period in the CD+CR group, but not in the CD group, compared with the control group. Improvement was also seen in adherence to antiretroviral drugs that were not the object of training and reinforcement. Eight weeks after training and reinforcement were discontinued, adherence in the cash-reinforced group returned to near-baseline levels.
CONCLUSIONS: Cue-dose training with cash reinforcement led to transient improvement in adherence to antiretroviral therapy in a population including mostly African Americans and subjects with histories of drug abuse. However, we were not able to detect any sustained improvement beyond the active training period, and questions concerning the timing and duration of such an intervention require further study. Randomized, controlled clinical studies with objective measures of adherence can be conducted in HIV-infected subjects and should be employed for further evaluation of this and other adherence interventions.
Similar content being viewed by others
References
Ioannidis JPA, Sacks HS, Cappellen JC, et al. Clinical efficacy of antiretroviral changes in treatment-experienced HIV-infected patients: a meta-analysis. Presented at the Fourth Conference on Retroviruses and Opportunistic Infections, Washington, DC: 1997.
Hammer SM, Squires KE, Hughes D, et al. A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. N Engl J Med. 1997;337:734–9.
Cameron DW, Heath-Chiozzi M, Danner S, et al. Randomized placebo-controlled trial of ritonavir in advanced HIV-1 disease. Lancet. 1998;351:543–9.
Haynes RB, McKibbon KA, Kanani R. Systematic review of randomized trials of interventions to assist patients to follow prescriptions for medications. Lancet. 1996;348:383–6.
Patterson DL, Swindels S, Mohm JA, et al. Adherence with protease inhibitor therapy for human immunodeficiency virus infections. Presented at the 38th Interscience Conference on Antimicrobial Agents and Chemotherapy. San Diego, Calif: 1998.
Melbourne K, Geletko S, Brown S, Willey C, Chase S, Fisher A. Electronic adherence assessment versus self-report in HIV-infected individuals. Presented at the 38th Interscience Conference on Antimicrobial Agents and Chemotherapy. San Diego, Calif: 1998.
Cramer JA. Enhancing patient adherence in the elderly. Role of packaging aids and monitoring. Drugs Aging. 1998;12:7–15.
Kosten TR, Rosen MI, McMahon TJ, et al. Treatment of early AIDS dementia in intravenous drug users: high versus low dose peptide T. Am J Drug Alcohol Abuse. 1997;23:543–53.
Cella DF, Bonomi AE. The Functional Assessment of Cancer Therapy (FACT) and Functional Assessment of HIV Infection (FAHI) quality of life measurement system. In: Spiker B, ed. Quality of Life and Pharmacoeconomics in Clinical Trials. 2nd ed. New York: Raven Publishers; 1995:203–14.
Derogatis LR, Lipman RS, Covi L. SCL-90: an outpatient psychiatric rating scale—preliminary report. Psychopharmacol Bull. 1973;4:13–28.
McLellan AT, Kushner H, Metzger D, et al. The Fifth Edition of the Addiction Severity Index. J Subst Abuse Treat. 1992;9:199–213.
Wallston KA, Stein MJ, Smith CA. Form C of the MHLC scales: condition-specific measure of locus of control. J Pers Assess. 1994;63:534–53.
Beck A, Ward CH, Mendelson M. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:461–71.
Stout RL, Wirtz PW, Carbonair JP, et al. Ensuring balanced distribution of prognostic factors in treatment outcome research. J Stud Alcohol Suppl. 1994;12:70–5.
McCance-Katz EF, Rainey PM, Jatlow P, Friedland G. Methadone effects on zidovudine disposition (ACTG 262). J Acquir Immune Defic Syndr. 1998;18:435–43.
Bryk AS, Raudenbush SW. Hierarchical Linear Models: Applications and Data Analysis Methods. Newbury Park, Calif: Sage Publications, Inc.; 1992.
Hedeker D, Gibbons RD. MIXREG: a computer program for mixed-effects regression analysis with autocorrelated errors. Comput Methods Programs Biomed. 1996;49:229–52.
Singh N, Squier C, Sivek C, Wagener M, Nguyen MH, Yu VL. Determinants of adherence with antiretroviral therapy in patients with human immunodeficiency virus: prospective assessment with implications for enhancing adherence. AIDS Care. 1996;8:261–9.
Preston KL, Silverman K, Umbrict A, et al. Improvement in naltrexone treatment adherence with contingency management. Drug Alcohol Depend. 1999;54:127–35.
Volmink J, Garner P. Systematic review of randomized controlled trials of strategies to promote adherence to tuberculosis treatment. BMJ. 1997;315:1403–6.
Stoner TJ, Down B, Carr WP, Maldonado G, Church TR, Mandel J. Do vouchers improve breast cancer screening rates? Results from a randomized trial. Health Serv Res. 1998;33:111–28.
Giuffrida A, Torgerson DJ. Should we pay the patient? Review of financial incentives to enhance patient adherence. BMJ. 1997;315:703–7.
Roter DL, Hall JA, Merisca R, Ruehle B, Cretin D, Svarstad B. Effectiveness of interventions to improve patient adherence: a metaanalysis. Med Care. 1998;36:1138–61.
Samet JH, Libman H, Steger KA, et al. Adherence with zidovudine therapy in patients infected with human immunodeficiency virus, type 1: a cross-sectional study in a municipal hospital clinic. Am J Med. 1992;92:495–502.
Author information
Authors and Affiliations
Corresponding author
Additional information
This study was supported by grants K20-DA000191-05 (MIR) and VA Merit Review 1241 (MIR), P50-DA09241 (BJR) and a General Clinical Research Center grant (M01RR06192) to the University of Connecticut Health Center, Farmington, Conn.
Rights and permissions
About this article
Cite this article
Rigsby, M.O., Rosen, M.I., Beauvais, J.E. et al. Cue-dose training with monetary reinforcement. J GEN INTERN MED 15, 841–847 (2000). https://doi.org/10.1046/j.1525-1497.2000.00127.x
Issue Date:
DOI: https://doi.org/10.1046/j.1525-1497.2000.00127.x