AIDS and Behavior

, Volume 11, Issue 1, pp 79–86

Efficacy of a Group Medication Adherence Intervention Among HIV Positive Women: The SMART/EST Women’s Project

  • Deborah L. Jones
  • Shvawn McPherson-Baker
  • David Lydston
  • Joanne Camille
  • Elizabeth Brondolo
  • Jonathan N. Tobin
  • Stephen M. Weiss
Original Paper


This intervention sought to improve overall quality of life and health behavior in women living with human immunodeficiency virus (HIV). We contrasted the effect of a group cognitive behavioral stress management expressive supportive therapy (CBSM+) intervention plus a healthier lifestyles (HL) component with an individual educational/informational format plus HL on HIV-medication adherence. Women, n = 237, predominantly African-American and Latina, living with HIV were recruited from Miami, New York and New Jersey and randomized to group or individual conditions (ten weekly sessions) plus group or individual HL, i.e., four conditions. Women reported relatively high levels of adherence at baseline. Participants in any of the group conditions increased self-reported adherence and emotion-focused coping skills in comparison with individual participation. This study suggests that group interventions may be an important adjunct in increasing medication adherence for HIV positive women.


Adherence Anti-retroviral therapy Women Behavioral interventions Psychosocial 


  1. Bangsberg, D. R., Hecht, F. M., Clague, H., Chalebois, E. D., Ciccarone, D., Chesney, M., et al. (2001). Provider assessment of adherence to HIV antiretroviral therapy. Journal of Acquired Immune Deficiency Syndrome, 26(Suppl. 5), 435–442.Google Scholar
  2. Baron, R. M., & Kenny D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.PubMedCrossRefGoogle Scholar
  3. Barre-Sinoussi, F., Chermann, J. C., Rey, F., Nugeyre, M. T., Chamaret, S., & Gruest, J. (1983). Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science, 220, 868–871.PubMedCrossRefGoogle Scholar
  4. Boden, D., Hurley, A., Zhang, L., Cao, Y., Guo, Y., Jones, E., et al. (1999). HIV-1 drug resistance in newly infected individuals. Journal of the American Medical Association, 282, 1135–1141.PubMedCrossRefGoogle Scholar
  5. Bogart, L. M., Gray-Bernhardt, M. L., Catz, S. L., Hartmann, B. R., & Otto-Salaj, L. L. (2002). Social and temporal comparisons made by individuals living with HIV disease: Relationships to adherence behavior. Journal of Applied Social Psychology, 32(Suppl. 8), 1551–1576.CrossRefGoogle Scholar
  6. Carpenter, C. C. J., Fischl, M. A., Hammer, S. M., Hirsch, M. S., Jacobsen, D. M., Katsenstein, D. A., et al. (2000). Antiretroviral therapy in adults updated recommendations of the international AIDS society—USA panel. Journal of the American Medical Association, 283, 381–390.PubMedCrossRefGoogle Scholar
  7. Carver, C., Sheier, M., & Weintraub, J. D. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56, 267–283.PubMedCrossRefGoogle Scholar
  8. Catz, S. L., Kelly, J. A., Bogart, L. M., Benotsch, E. G., & Mcauliffe, T. (2000). Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychology, 19(Suppl. 2), 124–133.PubMedCrossRefGoogle Scholar
  9. Chesney, M., & Ickovics, J. (1997). For the recruitment, adherence and retention committee of the ACTG: Adherence to combination therapy in AIDS clinical trials. Presented at the annual meeting of the AIDS Clinical Trials Group, Washington.Google Scholar
  10. Deeks, S., Beatty, G., Cohen, P. T., Grant, R., & Volberding, P. (1998). Viral load and CD+ T cell changes in patients failing potent protease inhibitor therapy [Abstract]. Fifth conference on Retroviruses and Opportunistic Infections, Chicago.Google Scholar
  11. Gordillo, V., Del Amo, J., Soriano, V., & Gonzlez-Lahoz, J. (1999). Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS, 13(Suppl. 13), 1763–1769.PubMedCrossRefGoogle Scholar
  12. Goujard, C., Bernard, N., Sohier, N., Peyramond, D., Lancon, F., Chwalow, J., et al. (2003). Impact of a patient education program on adherence to HIV medication: A randomized clinical trial. Journal of Acquired Immune Deficiency Syndrome, 34(Suppl. 2), 191–194.CrossRefGoogle Scholar
  13. Hill, Z., Kendall, C., & Fernandez, M. (2003). Patterns of adherence to antiretrovirals: Why adherence has no simple measure. AIDS Patient Care STDs, 17(Suppl. 10), 519–525.PubMedCrossRefGoogle Scholar
  14. Hogg, R. S., Chan, K. J., Wood, E., Craib, K. J., O'Shaughnessy, M. V., & Montaner, J. S. (2001). Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy. Journal of the American Medical Association, 286(20), 2597-2599.Google Scholar
  15. Horne R., Weinman J., & Hankins, M. (1991). The beliefs about medicines questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication. Psychology and Health, 12, 1–24.Google Scholar
  16. Ingledew, D. K., Hardy, L., Cooper, C. L., & Jemal, H. (1996). Health behaviours reported as coping strategies: A factor analytical study. British Journal of Health Psychology, 1, 263–281.Google Scholar
  17. Kalichman, S. C., Rompa, D., Difonzo, K., Simpson, D., Austin, J., Luke, W., et al. (2001). HIV treatment adherence in women living with HIV/AIDS: Research based on the information–motivation–behavioral skills model of health behavior. Journal of the Association of Nurses in AIDS Care, 12(Suppl. 4), 58–67.PubMedCrossRefGoogle Scholar
  18. Kievits, T., van Gemen, B., van Strijp, D., Schukkink, R., Dircks, M., & Adriaanse, H. (1991). NASBA isothermal enzymatic in vitro nucleic acid amplification optimized for the diagnosis of HIV-1 infection. Journal of Virology Methods, 35(3), 273–286.CrossRefGoogle Scholar
  19. LaPerriere, A., Ironson, G., Antoni, M., Jones, D., Devieux, J., Ishii, M., et al. (2005). CBSM+ group intervention decreases depression in moderately depressed women with AIDS: The SMART/EST Women’s Project. Journal of Health Psychology, 10, 223–231.PubMedCrossRefGoogle Scholar
  20. Malcolm, S. E., Ng, J. J., Rosen, R. K., & Stone, V. E. (2003). An examination of HIV/AIDS patients who have excellent adherence to HAART. AIDS Care, 15(Suppl. 2), 251–261.PubMedCrossRefGoogle Scholar
  21. McPherson-Baker, S., Malow, R., Penedo, F., Jones, D., Schneiderman, N., & Klimas, N. (2000). Enhancing adherence to combination antiretroviral therapy in non-adherent HIV-positive men. AIDS Care, 12, 399–404.PubMedCrossRefGoogle Scholar
  22. Pakenham, K. I. (1998). Specification of social support behaviours and network dimensions along the HIV continuum for gay men. Patient Education, 34(2), 147–157.CrossRefGoogle Scholar
  23. Paterson, D. L., Potoski, B., & Capitano, B. (2002). Measurement of adherence to antiretroviral medications. Journal of Acquired Immune Deficiency Syndrome, 31(Suppl. 3), S103–S106.Google Scholar
  24. Paterson, D. L., Swindells, S., Mohr, J., Brester, M., Vergis, E. N., Squier, C., et al. (2000). Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine, 133(Suppl. 1), 21–30.PubMedGoogle Scholar
  25. Reiter, G. S., Stewart, K. E., & Wojtusik, L. (2000). Elements of success in HIV clinical care: Multiple interventions that promote adherence. Topics in HIV Medicine, 8(Suppl. 5), 21–30.Google Scholar
  26. Remien, R. H., Hirky, A. E., Johnson, M. O., Weinhardt, L. S., Whittier, D., & Minh Le, G. (2003). Adherence to medication treatment: A qualitative study of facilitators and barriers among a diverse sample of HIV+ men and women in four U.S. cities. AIDS and Behavior, 7(Suppl. 1), 61–72.CrossRefGoogle Scholar
  27. Sankar, A., Luborsky, M., Schuman, P., & Roberts, G. (2002). Adherence discourse among African-American women taking HAART. AIDS Care, 14(Suppl. 2), 203–218.PubMedCrossRefGoogle Scholar
  28. Segal-Isaacson, C. J., Tobin, J. N., Weiss, S. M., Brondolo, E., Vaughn, A., Wang, C., et al. (2006). Improving dietary habits in disadvantaged women with HIV/AIDS: The SMART/EST Women’s Project. AIDS and Behavior (in press).Google Scholar
  29. Simoni, J. M., Frick, P. A., Lockhart, D., & Liebovitz, D. (2002). Mediators of social support and antiretroviral adherence among an indigent population in New York city. AIDS Patient Care and STDs, 16(Suppl. 9), 431–439.PubMedCrossRefGoogle Scholar
  30. Spiegel, D., & Yalom, I. (1981). Group support for patients with metastatic breast cancer. Archives of General Psychiatry, 38, 527–533.PubMedGoogle Scholar
  31. Stone, V. E., Hogan, J. W., Schuman, P., Rompalo, A. M., Howard, A. A., Korkontzelou, C., et al. (2001). Antiretroviral regimen complexity, self-reported adherence, and HIV patient’s understanding of their regimens: Survey of women in the HER study. Journal of Acquired Immune Deficiency Syndrome, 28(Suppl. 2), 124–131.Google Scholar
  32. Wagner, G. J., Remien, R. H., Carballo-Dieguez, A., & Dolezal, C. (2002). Correlates of adherence to combination antiretroviral therapy among members of HIV-positive mixed status couples. AIDS Care, 14(Suppl. 1), 105–109.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Deborah L. Jones
    • 1
  • Shvawn McPherson-Baker
    • 2
  • David Lydston
    • 3
  • Joanne Camille
    • 4
  • Elizabeth Brondolo
    • 5
  • Jonathan N. Tobin
    • 4
  • Stephen M. Weiss
    • 6
  1. 1.Department of PsychologyBarry UniversityMiami ShoresUSA
  2. 2.Veterans Affairs Medical CenterMiamiUSA
  3. 3.University of MiamiMiamiUSA
  4. 4.Clinical Directors NetworkNew YorkUSA
  5. 5.St. John’s UniversityJamaicaUSA
  6. 6.University of Miami Miller School of MedicineMiamiUSA

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