AIDS and Behavior

, Volume 15, Issue 5, pp 919–929

A Preliminary Randomized Controlled Trial of a Nurse-Delivered Medication Adherence Intervention Among HIV-Positive Outpatients Initiating Antiretroviral Therapy in Beijing, China

  • Jane M. Simoni
  • Wei-Ti Chen
  • David Huh
  • Karen I. Fredriksen-Goldsen
  • Cynthia Pearson
  • Hongxin Zhao
  • Cheng-Shi Shiu
  • Xin Wang
  • Fujie Zhang
Original Paper


We evaluated a nurse-delivered adherence intervention in a preliminary randomized controlled trial among 70 HIV-positive outpatients initiating antiretroviral therapy (ART) in Beijing, China. In both arms, participants received a 30-min educational session, a pillbox, and a referral to a peer support group. In the enhanced arm, participants could choose an electronic reminder device, three sessions of counseling either alone or with a treatment adherence partner, or both reminder and counseling. Survey assessments and blood draws occurred at baseline, post-intervention (13 weeks), and follow-up (25 weeks). Primary outcomes were 7-day and 30-day adherence assessed by self-report and electronic drug monitoring (EDM), and secondary outcomes were HIV-1 RNA viral load and CD4 count. The intervention was feasible and well received. It led to some improvement in self-reported and EDM-assessed adherence but not the biological outcomes. Providing counseling and facilitating the use of electronic reminders to patients initiating ART merits further investigation as a culturally viable means of promoting adherence in China.


HIV/AIDS Adherence Counseling China Nursing 


  1. 1.
    Gill B, Okie S. China and HIV—a window of opportunity. N Engl J Med. 2007;356(18):1801–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Wu Z, Sullivan SG, Wang Y, Rotheram-Borus MJ, Detels R. Evolution of China’s response to HIV/AIDS. Lancet. 2007;369(9562):679–90.PubMedCrossRefGoogle Scholar
  3. 3.
    Xinhua S. China’s health minister warns of HIV spread. China Daily. 2009, November 24.Google Scholar
  4. 4.
    Wu Z, Rou K, Cui H. The HIV/AIDS epidemic in China: history, current strategies and future challenges. AIDS Educ Prev. 2004;16(3 Suppl A):7–17.PubMedCrossRefGoogle Scholar
  5. 5.
    Ma Y, Zhao D, Yu L, Bulterys M, Robinson ML, Zhao Y, et al. Predictors of virologic failure in HIV-1-infected adults receiving first-line antiretroviral therapy in 8 provinces in China. Clin Infect Dis. 2010;50(2):264–71.PubMedCrossRefGoogle Scholar
  6. 6.
    Zhang F, Dou Z, Ma Y, Zhao Y, Liu Z, Bulterys M, et al. Five-year outcomes of the China National Free Antiretroviral Treatment Program. Ann Intern Med. 2009;151(4):241–51. W-52.PubMedGoogle Scholar
  7. 7.
    Zhang F, Chen RY, Lo SN, Ye M, editors. A decade of HAART: the development and global impact of highly active antiretroviral therapy. Chicago, IL: University of Chicago Press; 2008.Google Scholar
  8. 8.
    Chen WT, Starks H, Shiu CS, Fredriksen-Goldsen K, Simoni J, Zhang F, et al. Chinese HIV-positive patients and their healthcare providers: contrasting Confucian versus Western notions of secrecy and support. ANS Adv Nurs Sci. 2007;30(4):329–42.PubMedGoogle Scholar
  9. 9.
    Li L, Sun S, Wu Z, Wu S, Lin C, Yan Z. Disclosure of HIV status is a family matter: field notes from China. J Fam Psychol. 2007;21(2):307–14.PubMedCrossRefGoogle Scholar
  10. 10.
    Sabin LL, Desilva MB, Hamer DH, Keyi X, Yue Y, Wen F, et al. Barriers to adherence to antiretroviral medications among patients living with HIV in southern China: a qualitative study. AIDS Care. 2008;20(10):1242–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Starks H, Simoni J, Zhao H, Huang B, Fredriksen-Goldsen K, Pearson C, et al. Conceptualizing antiretroviral adherence in Beijing, China. AIDS Care. 2008;20(6):607–14.PubMedCrossRefGoogle Scholar
  12. 12.
    Wang H, He G, Li X, Yang A, Chen X, Fennie KP, et al. Self-reported adherence to antiretroviral treatment among HIV-infected people in Central China. AIDS Patient Care STDS. 2008;22(1):71–80.PubMedCrossRefGoogle Scholar
  13. 13.
    Li H. HIV/AIDS and the promises of the government. San lian Life Weekly. 2003;265:22–5. (Chinese).Google Scholar
  14. 14.
    Zhang FJ, Pan J, Yu L, Wen Y, Zhao Y. Current progress of China’s free ART program. Cell Res. 2005;15(11–12):877–82.PubMedCrossRefGoogle Scholar
  15. 15.
    Amico KR, Harman JJ, Johnson BT. Efficacy of antiretroviral therapy adherence interventions: a research synthesis of trials, 1996 to 2004. J Acquir Immune Defic Syndr. 2006;41(3):285–97.PubMedCrossRefGoogle Scholar
  16. 16.
    Simoni JM, Pearson CR, Pantalone DW, Marks G, Crepaz N. Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load. A meta-analytic review of randomized controlled trials. J Acquir Immune Defic Syndr. 2006;43(Suppl 1):S23–35.PubMedGoogle Scholar
  17. 17.
    Remien RH, Stirratt MJ, Dolezal C, Dognin JS, Wagner GJ, Carballo-Dieguez A, et al. Couple-focused support to improve HIV medication adherence: a randomized controlled trial. AIDS. 2005;19(8):807–14.PubMedCrossRefGoogle Scholar
  18. 18.
    Pearson CR, Micek MA, Simoni JM, Hoff PD, Matediana E, Martin DP, et al. Randomized control trial of peer-delivered, modified directly observed therapy for HAART in Mozambique. J Acquir Immune Defic Syndr. 2007;46(2):238–44.PubMedCrossRefGoogle Scholar
  19. 19.
    Safren SA, Otto MW, Worth JL. Life-steps: applying cognitive behavioral therapy to HIV medication adherence. Cogn Behav Pract. 1999;6:332–41.CrossRefGoogle Scholar
  20. 20.
    Safren SA, Otto MW, Worth JL, Salomon E, Johnson W, Mayer K, et al. Two strategies to increase adherence to HIV antiretroviral medication: life-steps and medication monitoring. Behav Res Ther. 2001;39(10):1151–62.PubMedCrossRefGoogle Scholar
  21. 21.
    Simoni JM, Huh D, Frick PA, Pearson CR, Andrasik MP, Dunbar PJ, et al. Peer support and pager messaging to promote antiretroviral modifying therapy in Seattle: a randomized controlled trial. J Acquir Immune Defic Syndr. 2009;52(4):465–73.PubMedCrossRefGoogle Scholar
  22. 22.
    Sabin LL, Desilva MB, Hamer DH, Xu K, Zhang J, Li T, et al. Using electronic drug monitor feedback to improve adherence to antiretroviral therapy among HIV-positive patients in China. AIDS Behav. 2010;14(3):580–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Gill CJ, Sabin LL, Hamer DH, Keyi X, Jianbo Z, Li T, et al. Importance of dose timing to achieving undetectable viral loads. AIDS Behav. 2010;14(4):785–93.PubMedCrossRefGoogle Scholar
  24. 24.
    Safren SA, Martin C, Menon S, Greer J, Solomon S, Mimiaga MJ, et al. A survey of MSM HIV prevention outreach workers in Chennai, India. AIDS Educ Prev. 2006;18(4):323–32.PubMedCrossRefGoogle Scholar
  25. 25.
    Chen W-T, Shiu C-S, Simoni J, Fredriksen-Goldsen K, Zhang F, Zhao H. Optimizing HIV care by expanding the nursing role in China: a qualitative study of patient and provider perspectives. J Adv Nurs. 2010;66(2):260–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Cook PF, McCabe MM, Emiliozzi S, Pointer L. Telephone nurse counseling improves HIV medication adherence: an effectiveness study. J Assoc Nurses AIDS Care. 2009;20(4):316–25.PubMedCrossRefGoogle Scholar
  27. 27.
    Ramirez-Garcia P, Cote J. Development of a nursing intervention to facilitate optimal antiretroviral-treatment taking among people living with HIV. BMC Health Serv Res. 2009;9(1):113.PubMedCrossRefGoogle Scholar
  28. 28.
    Williams AB, Fennie KP, Bova CA, Burgess JD, Danvers KA, Dieckhaus KD. Home visits to improve adherence to highly active antiretroviral therapy: a randomized controlled trial. J Acquir Immune Defic Syndr. 2006;42(3):314–21.PubMedCrossRefGoogle Scholar
  29. 29.
    Agresti A. A survey of exact inference for contingency tables. Stat Sci. 1992;7:131–53.CrossRefGoogle Scholar
  30. 30.
    Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73(1):13–22.CrossRefGoogle Scholar
  31. 31.
    Agresti A. Modelling patterns of agreement and disagreement. Stat Methods Med Res. 1992;1(2):201–18.PubMedCrossRefGoogle Scholar
  32. 32.
    Wang X, Wu Z. Factors associated with adherence to antiretroviral therapy among HIV/AIDS patients in rural China. AIDS. 2007;21(Suppl 8):S149–55.PubMedCrossRefGoogle Scholar
  33. 33.
    Mills EJ, Nachega JB, Buchan I, Orbinski J, Attaran A, Singh S, et al. Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. JAMA. 2006;296(6):679–90.PubMedCrossRefGoogle Scholar
  34. 34.
    Arnsten JH, Li X, Mizuno Y, Knowlton AR, Gourevitch MN, Handley K, et al. Factors associated with antiretroviral therapy adherence and medication errors among HIV-infected injection drug users. J Acquir Immune Defic Syndr. 2007;46(Suppl 2):S64–71.PubMedGoogle Scholar
  35. 35.
    Simoni JM, Kurth AE, Pearson CR, Pantalone DW, Merrill JO, Frick PA. Self-report measures of antiretroviral therapy adherence: a review with recommendations for HIV research and clinical management. AIDS Behav. 2006;10(3):227–45.PubMedCrossRefGoogle Scholar
  36. 36.
    de Bruin M, Viechtbauer W, Hospers HJ, Schaalma HP, Kok G. Standard care quality determines treatment outcomes in control groups of HAART-adherence intervention studies: implications for the interpretation and comparison of intervention effects. Health Psychol. 2009;28(6):668–74.PubMedCrossRefGoogle Scholar
  37. 37.
    Sharples K, Breslow N. Regression analysis of correlated binary data: some small sample results for the estimating equation approach. J Stat Comput Simul. 1992;42(1):1–20.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Jane M. Simoni
    • 1
  • Wei-Ti Chen
    • 2
  • David Huh
    • 1
  • Karen I. Fredriksen-Goldsen
    • 3
  • Cynthia Pearson
    • 3
  • Hongxin Zhao
    • 4
  • Cheng-Shi Shiu
    • 5
  • Xin Wang
    • 4
  • Fujie Zhang
    • 6
  1. 1.Department of PsychologyUniversity of WashingtonSeattleUSA
  2. 2.Department of Family and Child Nursing, School of NursingUniversity of WashingtonSeattleUSA
  3. 3.School of Social WorkUniversity of WashingtonSeattleUSA
  4. 4.Institute of Infectious DiseasesCapital Medical University, Ditan HospitalBeijingChina
  5. 5.School of Social Service AdministrationUniversity of ChicagoChicagoUSA
  6. 6.Division of Treatment and CareNational Center for AIDS/STD Control and PreventionBeijingChina

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