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Improving Adherence to Care Among “Hard to Reach” HIV-Infected Patients in Argentina

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Abstract

Many HIV-infected patients fail to achieve undetectable viral load and are not retained in care. This pilot study examined patients lost to care in public and private clinics in Buenos Aires, Argentina. The impact of patient and provider interventions was compared separately and collectively. In Phase 1, participants prescribed antiretrovirals and non-adherent to treatment in the prior 3–6 months (n = 60) were randomized to patient intervention or standard of care (SOC) and assessed over 12 months. In Phase 2, providers were trained in interviewing techniques and 60 additional patients were randomized to patient intervention or SOC condition. Averaged across patient intervention status, Phase 2 provider intervention patients reported the most improved adherence and viral suppression at 6 and 12 months. Adherence in “patient intervention only” improved at midpoint and returned to baseline at 12 months. Results suggest provider training sustained patient adherence and viral suppression among “hard to reach” patients.

Resumen

Muchos pacientes con VIH no logran alcanzar una carga viral indetectable y no permanecen en tratamiento. Esta investigación piloto examinó pacientes que habían abandonado su tratamiento en clínicas públicas y privadas en Buenos Aires, Argentina. El impacto de dos intervenciones de pacientes y proveedores se comparó por separado y en conjunto. En la Fase 1, los participantes que fueron prescritos antirretrovirales (ARVs) y que no habían sido adherentes al tratamiento en los 3 a 6 meses anteriores (n = 60) fueron asignados al azar a la intervención del paciente o estándar de cuidado (EOC) y fueron evaluados 12 meses después. En la Fase 2, los proveedores fueron capacitados en técnicas de entrevista y 60 pacientes más fueron asignados al azar a la intervención de pacientes o condición EOC. No tomando en cuenta el tipo de intervención del paciente, los pacientes en la Fase 2 en la intervención del proveedor reportaron mejor adherencia y supresión viral a los 6 y 12 meses. Por otro lado, la adhesión en la intervención de pacientes mejoró en el punto medio y regresó a la línea de base a los 12 meses. Los resultados sugieren que la capacitación profesional para proveedores ayudó a mantener adhesión y supresión viral entre esos pacientes que eran difíciles de alcanzar.

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Acknowledgments

This study was supported by a grant from the National Institutes of Health, R34MH097609. We wish to thank all the members of the COPA team, including Celia Trejo, Inés Arístegui, Analía Dorigo, Virginia Zalazar, and Ana Gun, as well as the patients and providers participating, without whom this research would not have been possible. The authors have no conflicts of interest.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, 1400 NW 10th Ave., Miami, FL, 33136, USA

    Deborah L. Jones, Lina Bofill, Ryan Cook & Stephen M. Weiss

  2. Clinical Research Department, Fundación Huésped, Buenos Aires, Argentina

    Omar Sued, Mar Lucas & Pedro Cahn

  3. Helíos Salud, Buenos Aires, Argentina

    Diego Cecchini, Alejandra Bordato & Isabel Cassetti

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  1. Deborah L. Jones
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  2. Omar Sued
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  3. Diego Cecchini
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  4. Lina Bofill
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  5. Ryan Cook
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  6. Mar Lucas
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  9. Pedro Cahn
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  10. Stephen M. Weiss
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Correspondence to Deborah L. Jones.

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Jones, D.L., Sued, O., Cecchini, D. et al. Improving Adherence to Care Among “Hard to Reach” HIV-Infected Patients in Argentina. AIDS Behav 20, 987–997 (2016). https://doi.org/10.1007/s10461-015-1133-8

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  • DOI: https://doi.org/10.1007/s10461-015-1133-8

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