AIDS and Behavior

, Volume 12, Supplement 1, pp 54–62 | Cite as

100% Adherence Study: Educational Workshops vs. Video Sessions to Improve Adherence Among ART-Naïve Patients in Salvador, Brazil

  • Marcia Sampaio-Sa
  • Kimberly Page-Shafer
  • David R. Bangsberg
  • Jennifer Evans
  • Maria de Lourdes Dourado
  • Celia Teixeira
  • Eduardo M. Netto
  • Carlos Brites
Original Paper

Abstract

We conducted a randomized trial to test an intervention aimed at increasing adherence to antiretroviral therapy (ART) among HIV-positive, ART-naïve patients in Salvador, Brazil. Participants (N = 107) were randomized to either educational workshops based on the information-motivation-behavioral skills model (n = 52) or a control video session (n = 55). Changes in self-reported ART adherence, viral load, CD4 cell counts and ART pharmacy records were measured periodically over 12 months. After 3–6 months, ART adherence (≥95%) was 77.8% in the workshop group and 85.7% in video group (as treated) and 53.8% and 65.5%, respectively, using intention-to-treat (ITT) analysis (both > 0.05) At 9–12 months, ART adherence decreased to 73.7% in the workshop group and 79.1% in the video group (as treated) and 53.8% and 61.8% using ITT, respectively. No differences were found in self-reported adherence, viral load or pharmacy records between groups. We found that the educational workshop intervention does not increase adherence to ART.

Keywords

Adherence AIDS HIV infection Highly active antiretroviral therapy (HAART) ART Brazil 

Notes

Acknowledgements

We wish to thank all the respondents who gave their valuable time to participate in this study. We also are indebted to the research team and staff from the Reference Center for AIDS Treatment (CREAIDS) in Salvador-Brazil for logistic support. This research was supported by a grant from the Brazilian National AIDS Program, Ministry of Health. We also would like to thank the University of California, San Francisco, Center for AIDS Prevention Studies (NIMH-P30 MH062246), the International Clinical, Operational and Health Services Research Training Award (ICOHRTA), Brazil Scientists Program, Fogarty International Center (D43TW005799) and the Starr Foundation AIDS International Scholarship Fund for their technical assistance and support during the writing of this paper. Dr. Bangsberg was supported by K24 AA015287.

References

  1. Altice, F. L., & Friedland, G. H. (1998). The era of adherence to HIV therapy. Annals of Internal Medicine, 129, 503–505. Editorial.PubMedGoogle Scholar
  2. Amico, K. R., Harman, J. J., & Johnson, B. T. (2006). Efficacy of antiretroviral therapy adherence interventions. A research synthesis of trials, 1996 to 2004. Journal of Acquired Immune Deficiency Syndromes, 41, 285–297. doi: 10.1097/01.qai.0000197870.99196.ea.PubMedCrossRefGoogle Scholar
  3. Amico, K. R., Toro-Alfonso, J., & Fisher, J. D. (2005). An empirical test of the information, motivation and behavioral skills model of antiretroviral therapy adherence. AIDS Care, 17(6), 661–673. doi: 10.1080/09540120500038058.PubMedCrossRefGoogle Scholar
  4. Bangsberg, D. R., Hecht, F. M., Charlebois, E. D., Zolopa, A. R., Holodniy, M., Sheiner, L., et al. (2000). Adherence to protease inhibitors, HIV-1, viral load, and development of drug resistance in an indigent population. AIDS (London, England), 14, 357–366. doi: 10.1097/00002030-200003100-00008.Google Scholar
  5. Bartlett, J. A. (2002). Addressing the challenges of adherence. Journal of Acquired Immune Deficiency Syndromes, 29(Suppl), S2–S10.PubMedGoogle Scholar
  6. Bastos, F. I., Kerrigan, D., Malta, M., Carneiro-da-Cunha, C., & Strathdee, A. S. (2001). Treatment for HIV/AIDS in Brazil: Strenghts, challenges, and opportunities for operational research. AIDScience (Science Knowledge Environment). Retrieved September 2, 2007, from http://www.aidscience.com.
  7. Brazilian Ministry of Health. (2001). Implementation and monitoring report—AIDS II—December 1988–May 2001. World Bank Loan BIRD 4392/BR (in Portuguese). Retrieved September 2, 2007 from http://www.aids.gov.br.
  8. Brazilian Ministry of Health. (2006). Recommendations for antiretroviral therapy in HIV-infected adults and adolescents (in Portuguese). Retrieved September 2, 2007 from http://www.aids.gov.br.
  9. Brigido, L. F. M., Rodrigues, R., Casseb, J., Oliveira, D., Rossetti, M., Menezes, P., et al. (2001). Impact of adherence to antiretroviral therapy in HIV-1 infected patients at a University Public Service in Brazil. AIDS patient care and STDs, 15(11), 587–593. doi: 10.1089/108729101753287685.
  10. Chesney, M. (2003). Adherence to HAART regimens. AIDS Patient Care and STDs, 17(4), 169–177.Google Scholar
  11. Chesney, M. A., Ickovics, J. R., Chambers, D. B., Gifford, A. L., Neidig, J., Zwickl, B., et al. (2000). Self-reported adherence to anti-retroviral medications among participants in HIV clinical trials: The AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care, 12, 255–256. doi: 10.1080/09540120050042891.PubMedCrossRefGoogle Scholar
  12. Fairley, C. K., Levy, R., Rayner, C. R., Allardice, K., Costello, K., Thomas, C., et al. (2003). Randomized trial of an adherence programme for clients with HIV. International Journal of STD & AIDS, 14, 805–809. doi: 10.1258/095646203322556129.CrossRefGoogle Scholar
  13. Fisher, W. A., Fisher, J. D., & Harman, J. J. (2003). The information, motivation, behavioral, skills model as a general model of health behavior change: Theoretical approaches to individual-level change. In J Suls & K. A. Wallston (Eds.), Social psychological foundations of health and Illness (pp. 127–153). London: Blackwell.Google Scholar
  14. Garcia, R., Schooley, R. T., & Badaro, R. (2003). An adherence trilogy is essential for long-term HAART success. The Brazilian Journal of Infectious Diseases, 7(5), 307–314. doi: 10.1590/S1413-86702003000500005.PubMedGoogle Scholar
  15. Hirsch, M. S., Conway, B., D’Aquila, R. T., Johnson, V. A., Brun-Vézinet, F., Clotet, B., et al. (1998). Antiretroviral drug resistance testing in adults with HIV infection: implications for clinical management. Journal of the American Medical Association, 279, 1984–1991. doi: 10.1001/jama.279.24.1984.PubMedCrossRefGoogle Scholar
  16. Levi, G. C., & Vitoria, M. A. A. (2002). Fighting against AIDS: The Brazilian experience. AIDS (London, England), 16, 2373–2383. doi: 10.1097/00002030-200212060-00001.Google Scholar
  17. Lyon, M. E., Trexler, C., Akpan-Townsend, C. P. M., Selden, K., Fletcher, J., Addlestone, I. C., et al. (2003). A family group approach to increasing adherence to therapy in HIV-infected youths: Results of a pilot project. AIDS Patient Care and STDs, 1, 299–308. doi: 10.1089/108729103322108175.CrossRefGoogle Scholar
  18. Mannheimer, S. B., Morse, E., Matts, J. P., Andrews, L., Child, C., Schmetter, B., et al. (2006). Sustained benefit from a long-term antiretroviral adherence intervention. Results from a large randomized clinical trial. Journal of Acquired Immune Deficiency Syndromes, 43, S41–S47. doi: 10.1097/01.qai.0000245887.58886.ac.PubMedCrossRefGoogle Scholar
  19. Marins, J. R. P., Jamal, L. F., Chen, S. Y., Barros, M. B., Hudes, E. S., Barbosa, A. A., et al. (2003). Dramatic improvement in survival among adult Brazilian AIDS patients. AIDS (London, England), 17, 1675–1682. doi: 10.1097/00002030-200307250-00012.Google Scholar
  20. Mocroft, A., Ledergerber, B., Katlama, C., Kirk, O., Reiss, P., d’Arminio Monforte, A., et al. (2003). Decline in the AIDS and death rates in the EuroSIDA study: An observational study. Lancet, 362, 22–29. doi: 10.1016/S0140-6736(03)13802-0.PubMedCrossRefGoogle Scholar
  21. Murphy, D. A., Lu, M. C., Martin, D., Hoffman, D., & Marelich, W. D. (2002). Results of a pilot intervention trial to improve anti-retroviral adherence among HIV-positive patients. The Journal of the Association of Nurses in AIDS Care, 13, 57–69. doi: 10.1177/1055329002238026.PubMedCrossRefGoogle Scholar
  22. Nemes, M. I. B., Carvalho, H. B., & Souza, M. F. M. (2004). Anti-retroviral therapy adherence in Brazil. AIDS (London, England), 18(3), S15–S20. doi: 10.1097/00002030-200406003-00004.Google Scholar
  23. Palella, F. J., Jr., Delaney, K. M., Moorman, A. C., Loveless, M. O., Fuhrer, J., Satten, G. A., et al. (1998). Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV outpatient study investigators. The New England Journal of Medicine, 338(13), 853–860. doi: 10.1056/NEJM199803263381301.PubMedCrossRefGoogle Scholar
  24. Paterson, D. L., Swindells, S., Mohr, J., Brester, M., Vergis, E. N., Squier, C., et al. (2002). Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine, 133, 21–30.Google Scholar
  25. Perno, C. F., Ceccherini-Silberstein, F., De Luca, A., Cozzi-Lepri, A., Gori, C., Cingolani, A., et al. (2002). Virologic correlates of adherence to antiretroviral medications and therapeutic failure. Journal of Acquired Immune Deficiency Syndromes, 31(3), S118–S122.PubMedGoogle Scholar
  26. Pinheiro, C. A. T., Leite, J. C. C., Drachler, M. L., & Silveira, V. L. (2002). Factors associated with adherence to antiretroviral therapy in HIV/AIDS patients: A cross-sectional study in Southern Brazil. Brazilian Journal of Medical and Biological Research, 35, 1173–1181.PubMedGoogle Scholar
  27. Remien, R. H., Stirratt, M. J., Dognin, J., Day, E., El-Bassel, N., & Warne, P. (2006). Moving from theory to research to practice. Implementing an effective dyadic intervention to improve antiretroviral adherence for clinic patients. Journal of Acquired Immune Deficiency Syndromes, 43, S69–S78. doi: 10.1097/01.qai.0000248340.20685.7d.PubMedCrossRefGoogle Scholar
  28. Safren, S. A., Otto, M. W., Worth, J. L., Salomon, E., Johnson, W., Mayer, K., et al. (2001). Two strategies to increase adherence to HIV anti-retroviral medication: Life-steps and medication monitoring. Behaviour Research and Therapy, 39, 1151–1162. doi: 10.1016/S0005-7967(00)00091-7.PubMedCrossRefGoogle Scholar
  29. Simoni, J. M., Frick, P. A., Pantalone, D. W., & Turner, B. J. (2003). Antriretroviral adherence interventions: A review of current literature and ongoing studies. Topics in HIV Medicine, 11, 185–198.PubMedGoogle Scholar
  30. Tesoriero, J., French, T., Weiss, L., Waters, M., Finkelstein, R., & Agins, B. (2003). Stability of adherence to highly active anti-retroviral therapy over time among clients enrolled in the treatment adherence demonstration project. Journal of Acquired Immune Deficiency Syndromes, 33, 484–493.PubMedGoogle Scholar
  31. Tuldra, A., Fumaz, C. R., Ferrer, M. J., Bayés, R., Arnó, A., Balagué, M., et al. (2000). Prospective randomized two-arm controlled study to determine the efficacy of a specific intervention to improve long-term adherence to highly active anti-retroviral therapy. Journal of Acquired Immune Deficiency Syndromes, 25, 221–228. doi: 10.1097/00042560-200011010-00003.PubMedCrossRefGoogle Scholar
  32. Wainberg, M. A., & Friedland, G. (1998). Public health implications of antiretroviral therapy and HIV drug resistance. Journal of the American Medical Association, 279, 1977–1983. doi: 10.1001/jama.279.24.1977.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Marcia Sampaio-Sa
    • 1
    • 2
  • Kimberly Page-Shafer
    • 3
  • David R. Bangsberg
    • 4
  • Jennifer Evans
    • 3
  • Maria de Lourdes Dourado
    • 2
  • Celia Teixeira
    • 2
  • Eduardo M. Netto
    • 1
  • Carlos Brites
    • 1
  1. 1.Federal University of BahiaSalvadorBrazil
  2. 2.Secretariat of Health of the State of BahiaSalvadorBrazil
  3. 3.University of CaliforniaSan FranciscoUSA
  4. 4.University of California, San Francisco, San Francisco General Hospital, California (UCSF-SFGH)San FranciscoUSA

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