100% Adherence Study: Educational Workshops vs. Video Sessions to Improve Adherence Among ART-Naïve Patients in Salvador, Brazil
- 288 Downloads
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 P > 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.
KeywordsAdherence AIDS HIV infection Highly active antiretroviral therapy (HAART) ART Brazil
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.
- 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
- 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.
- 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.
- 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.
- 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.
- Chesney, M. (2003). Adherence to HAART regimens. AIDS Patient Care and STDs, 17(4), 169–177.Google Scholar
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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