AIDS and Behavior

, Volume 17, Issue 1, pp 104–112

Effect of a Clinic-Wide Social Marketing Campaign to Improve Adherence to Antiretroviral Therapy for HIV Infection

  • Thomas P. Giordano
  • Sonia Rodriguez
  • Hong Zhang
  • Michael A. Kallen
  • Maria Jibaja-Weiss
  • April L. Buscher
  • Monisha Arya
  • Maria E. Suarez-Almazor
  • Michael Ross
Original Paper


This demonstration study tested the impact of a 5-month clinic-wide social marketing campaign at improving adherence to antiretroviral therapy (ART). The intervention included a video, posters, pens, mugs, and lapel buttons with the campaign slogan “Live the Solution: Take Your Pills Every Day.” Participants self-reported adherence over a 4-week interval, the primary outcome, with a visual analogue scale. Pre- and post-intervention surveys were completed by 141 participants. Adherence did not change over time (absolute mean change −2.02 %, paired t test P = 0.39). Among the 39.7 % of participants who correctly identified the campaign slogan on the post-intervention survey, adherence increased by 3.3 %, while it decreased in the other participants by 5.5 % (paired t test P = 0.07). The well-received campaign did not increase short-term adherence to ART, but adherence tended to increase in participants who were more engaged with the intervention. Future interventions should engage patients more completely and have a more potent effect on adherence.


HIV/AIDS Social marketing Adherence Behavioral interventions Clinical trial 


El estudio demostrativo puso a prueba por 5 meses en una clínica el impacto de una campaña de mercadeo social para mejorar la adherencia a la terapia antirretroviral (TAR). La intervención incluyó un video, posters, bolígrafos, tazas y botones para la solapa con el lema de la campaña “Vive la Solución: Toma tus pastillas todos los días.” Participantes reportaron su adhesión por un intervalo de 4 semanas con una escala visual analógica. Encuestas fueron completadas por 141 participantes antes y después de la intervención. La adhesión no cambió con el tiempo (cambio medio absoluto de −2,02 %, a la par t test, P = 0,39). Entre el 39,7 % de los participantes que identificaron correctamente el eslogan de la campaña en la encuesta post-intervención, la adherencia aumentó un 3,3 %, mientras que disminuyó en los otros participantes en un 5,5 % (t test P = 0,07). La campaña fue bien recibida, no aumentó la adhesión a TAR a corto plazo, pero adhesión tendió a aumentar en los participantes que estuvieron más comprometidos con la intervención. Futuras intervenciones deberían involucrar pacientes en forma más completa para tener un efecto más potente en adherencia.


  1. 1.
    de Olalla P, Knobel H, Carmona A, Guelar A, Lopez-Colomes JL, Cayla JA. Impact of adherence and highly active antiretroviral therapy on survival in HIV-infected patients. J Acquir Immune Defic Syndr. 2002;30(1):105–10.Google Scholar
  2. 2.
    Paterson DL, Swindells S, Mohr J, Brester M, Vergis EN, Squier C, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133(1):21–30.PubMedGoogle Scholar
  3. 3.
    Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.PubMedCrossRefGoogle Scholar
  4. 4.
    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
  5. 5.
    Johnson MO, Charlebois E, Morin SF, Remien RH, Chesney MA. Effects of a behavioral intervention on antiretroviral medication adherence among people living with HIV: the healthy living project randomized controlled study. J Acquir Immune Defic Syndr. 2007;46(5):574–80.PubMedCrossRefGoogle Scholar
  6. 6.
    Parsons JT, Golub SA, Rosof E, Holder C. Motivational interviewing and cognitive-behavioral intervention to improve HIV medication adherence among hazardous drinkers: a randomized controlled trial. J Acquir Immune Defic Syndr. 2007;46(4):443–50.PubMedCrossRefGoogle Scholar
  7. 7.
    Safren SA, O’Cleirigh C, Tan JY, Raminani SR, Reilly LC, Otto MW, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychol. 2009;28(1):1–10.PubMedCrossRefGoogle Scholar
  8. 8.
    Wagner GJ, Kanouse DE, Golinelli D, Miller LG, Daar ES, Witt MD, et al. Cognitive-behavioral intervention to enhance adherence to antiretroviral therapy: a randomized controlled trial (CCTG 578). AIDS. 2006;20(9):1295–302.PubMedCrossRefGoogle Scholar
  9. 9.
    Evans WD. How social marketing works in health care. BMJ. 2006;332(7551):1207–10.PubMedCrossRefGoogle Scholar
  10. 10.
    Kotler P, Zaltman G. Social marketing: an approach to planned social change. J Mark. 1971;35(3):3–12.PubMedCrossRefGoogle Scholar
  11. 11.
    Kotler DP, Roberto N, Lee N. Social marketing: improving the quality of life. 2nd ed. Thousand Oaks: Sage; 2002.Google Scholar
  12. 12.
    Goldberg M, Fishbein M, Middlestadt E. Social marketing: theoretical and practical perspectives. 2nd ed. Mahwah: Lawrence Erlbaum; 1997.Google Scholar
  13. 13.
    Gibson DR, Zhang G, Cassady D, Pappas L, Mitchell J, Kegeles SM. Effectiveness of HIV prevention social marketing with injecting drug users. Am J Public Health. 2010;100(10):1828–30.PubMedCrossRefGoogle Scholar
  14. 14.
    Kennedy MG, Mizuno Y, Seals BF, Myllyluoma J, Weeks-Norton K. Increasing condom use among adolescents with coalition-based social marketing. AIDS. 2000;14(12):1809–18.PubMedCrossRefGoogle Scholar
  15. 15.
    Martinez-Donate AP, Zellner JA, Sanudo F, Fernandez-Cerdeno A, Hovell MF, Sipan CL, et al. Hombres Sanos: evaluation of a social marketing campaign for heterosexually identified Latino men who have sex with men and women. Am J Public Health. 2010;100(12):2532–40.PubMedCrossRefGoogle Scholar
  16. 16.
    Johnson MO, Neilands TB, Dilworth SE, Morin SF, Remien RH, Chesney MA. The role of self-efficacy in HIV treatment adherence: validation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). J Behav Med. 2007;30(5):359–70.PubMedCrossRefGoogle Scholar
  17. 17.
    Parsons JT, Rosof E, Mustanski B. Medication adherence mediates the relationship between adherence self-efficacy and biological assessments of HIV health among those with alcohol use disorders. AIDS Behav. 2008;12(1):95–103.PubMedCrossRefGoogle Scholar
  18. 18.
    Johnson MO, Chesney MA, Goldstein RB, Remien RH, Catz S, Gore-Felton C, et al. Positive provider interactions, adherence self-efficacy, and adherence to antiretroviral medications among HIV-infected adults: a mediation model. AIDS Patient Care STDS. 2006;20(4):258–68.PubMedCrossRefGoogle Scholar
  19. 19.
    Rochon D, Ross MW, Looney C, Nepal VP, Price AJ, Giordano TP. Communication strategies to improve HIV treatment adherence. Health Commun. 2011;26(5):461–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Cully JA, Mignogna J, Stanley MA, Davila J, Wear J, Amico KR, et al. Development and pilot testing of a standardized training program for a patient-mentoring intervention to increase adherence to outpatient HIV care. AIDS Patient Care STDS. 2012;26(3):165–72.PubMedCrossRefGoogle Scholar
  21. 21.
    Giordano TP, Guzman D, Clark R, Charlebois ED, Bangsberg DR. Measuring adherence to antiretroviral therapy in a diverse population using a visual analogue scale. HIV Clin Trials. 2004;5(2):74–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Walsh JC, Mandalia S, Gazzard BG. Responses to a 1 month self-report on adherence to antiretroviral therapy are consistent with electronic data and virological treatment outcome. AIDS. 2002;16(2):269–77.PubMedCrossRefGoogle Scholar
  23. 23.
    Lu M, Safren SA, Skolnik PR, Rogers WH, Coady W, Hardy H, et al. Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav. 2008;12(1):86–94.PubMedCrossRefGoogle Scholar
  24. 24.
    Ortego C, Huedo-Medina TB, Llorca J, Sevilla L, Santos P, Rodriguez E, et al. Adherence to highly active antiretroviral therapy (HAART): a meta-analysis. AIDS Behav. 2011;15(7):1381–96.PubMedCrossRefGoogle Scholar
  25. 25.
    Mannheimer S, Thackeray L, Huppler Hullsiek K, Chesney M, Gardner EM, Wu AW, et al. A randomized comparison of two instruments for measuring self-reported antiretroviral adherence. AIDS Care. 2008;20(2):161–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Simoni JM, Amico KR, Smith L, Nelson K. Antiretroviral adherence interventions: translating research findings to the real world clinic. Curr HIV/AIDS Rep. 2010;7(1):44–51.PubMedCrossRefGoogle Scholar
  27. 27.
    Wu Z, Luo W, Sullivan SG, Rou K, Lin P, Liu W, et al. Evaluation of a needle social marketing strategy to control HIV among injecting drug users in China. AIDS. 2007;21(Suppl 8):S115–22.PubMedCrossRefGoogle Scholar
  28. 28.
    Olshefsky AM, Zive MM, Scolari R, Zuniga M. Promoting HIV risk awareness and testing in Latinos living on the U.S.–Mexico border: the Tu No Me Conoces social marketing campaign. AIDS Educ Prev. 2007;19(5):422–35.PubMedCrossRefGoogle Scholar
  29. 29.
    Hightow-Weidman LB, Smith JC, Valera E, Matthews DD, Lyons P. Keeping them in “STYLE”: finding, linking, and retaining young HIV-positive black and Latino men who have sex with men in care. AIDS Patient Care STDS. 2011;25(1):37–45.PubMedCrossRefGoogle Scholar
  30. 30.
    Keating J, Meekers D, Adewuyi A. Assessing effects of a media campaign on HIV/AIDS awareness and prevention in Nigeria: results from the VISION Project. BMC Public Health. 2006;6:123.PubMedCrossRefGoogle Scholar
  31. 31.
    Ross DA, Changalucha J, Obasi AI, Todd J, Plummer ML, Cleophas-Mazige B, et al. Biological and behavioural impact of an adolescent sexual health intervention in Tanzania: a community-randomized trial. AIDS. 2007;21(14):1943–55.PubMedCrossRefGoogle Scholar
  32. 32.
    Lapinski MK, Nwulu P. Can a short film impact HIV-related risk and stigma perceptions? Results from an experiment in Abuja, Nigeria. Health Commun. 2008;23(5):403–12.PubMedCrossRefGoogle Scholar
  33. 33.
    Guy R, Goller J, Leslie D, Thorpe R, Grierson J, Batrouney C, et al. No increase in HIV or sexually transmissible infection testing following a social marketing campaign among men who have sex with men. J Epidemiol Community Health. 2009;63(5):391–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Burns SP, Nelson AL, Bosshart HT, Goetz LL, Harrow JJ, Gerhart KD, et al. Implementation of clinical practice guidelines for prevention of thromboembolism in spinal cord injury. J Spinal Cord Med. 2005;28(1):33–42.PubMedGoogle Scholar
  35. 35.
    Goetz MB, Hoang T, Bowman C, Knapp H, Rossman B, Smith R, et al. A system-wide intervention to improve HIV testing in the Veterans Health Administration. J Gen Intern Med. 2008;23(8):1200–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Griffen E. A first look at communication theory. 4th ed. Boston: McGraw-Hill; 2000.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Thomas P. Giordano
    • 1
    • 2
    • 3
    • 9
  • Sonia Rodriguez
    • 4
  • Hong Zhang
    • 4
  • Michael A. Kallen
    • 4
    • 7
  • Maria Jibaja-Weiss
    • 5
  • April L. Buscher
    • 1
    • 2
    • 3
    • 8
  • Monisha Arya
    • 1
    • 2
    • 3
  • Maria E. Suarez-Almazor
    • 4
  • Michael Ross
    • 6
  1. 1.Health Services Research and Development Center of ExcellenceMichael E. DeBakey VA Medical CenterHoustonUSA
  2. 2.Thomas Street Health CenterHoustonUSA
  3. 3.Department of MedicineBaylor College of MedicineHoustonUSA
  4. 4.Department of General Internal MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA
  5. 5.Department of Family and Community MedicineBaylor College of MedicineHoustonUSA
  6. 6.Center for Health Promotion and Prevention ResearchThe University of Texas Health Science Center at Houston School of Public HealthHoustonUSA
  7. 7.Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoUSA
  8. 8.Ambulatory Care ServiceDurham VA Medical CenterDurhamUSA
  9. 9.Baylor College of Medicine and Thomas Street Health CenterHoustonUSA

Personalised recommendations