AIDS and Behavior

, Volume 19, Issue 1, pp 145–156

Individualised Motivational Counselling to Enhance Adherence to Antiretroviral Therapy is not Superior to Didactic Counselling in South African Patients: Findings of the CAPRISA 058 Randomised Controlled Trial

  • Francois van Loggerenberg
  • Alison D. Grant
  • Kogieleum Naidoo
  • Marita Murrman
  • Santhanalakshmi Gengiah
  • Tanuja N. Gengiah
  • Katherine Fielding
  • Salim S. Abdool Karim
Original Paper

Abstract

Concerns that standard didactic adherence counselling may be inadequate to maximise antiretroviral therapy (ART) adherence led us to evaluate more intensive individualised motivational adherence counselling. We randomised 297 HIV-positive ART-naïve patients in Durban, South Africa, to receive either didactic counselling, prior to ART initiation (n = 150), or an intensive motivational adherence intervention after initiating ART (n = 147). Study arms were similar for age (mean 35.8 years), sex (43.1 % male), CD4+ cell count (median 121.5 cells/μl) and viral load (median 119,000 copies/ml). Virologic suppression at 9 months was achieved in 89.8 % of didactic and 87.9 % of motivational counselling participants (risk ratio [RR] 0.98, 95 % confidence interval [CI] 0.90–1.07, p = 0.62). 82.9 % of didactic and 79.5 % of motivational counselling participants achieved >95 % adherence by pill count at 6 months (RR 0.96, 95 % CI 0.85–1.09, p = 0.51). Participants receiving intensive motivational counselling did not achieve higher treatment adherence or virological suppression than those receiving routinely provided didactic adherence counselling. These data are reassuring that less resource intensive didactic counselling was adequate for excellent treatment outcomes in this setting.

Keywords

Antiretroviral therapy adherence IMB Motivational interviewing HIV 

Resumen

La inquietud de que la terapia didáctica de adherencia estándar pudiera ser inadecuada para maximizar la adherencia al tratamiento antiretroviral (ART), nos llevó a evaluar la terapia motivacional individualizada. Aleatorizamos 297 pacientes HIV-positivos sin ART previo en Durban, Sudáfrica, para recibir, ya sea terapia didáctica antes del inicio del ART (n = 150), o terapia motivacional intensiva después de iniciado el ART (n = 147). Los brazos del estudio fueron similares en edad (promedio 35.8 años), sexo (43.1 % hombres), recuento de células CD4+ (mediana 121.5 células/μl) y carga viral (mediana 119,000 copias/ml). La supresión virológica a los nueves meses se logró en el 89.8 % de los participantes que recibieron terapia didáctica y en 87.9 % de aquellos en terapia motivacional (riesgo relativo [RR] 0.98, 95 % intervalo de confianza [CI] 0.90–1.07, p = 0.62). 82.9 % de los participantes bajo terapia didáctica y 79.5 % de los tratados con terapia motivacional alcanzaron >95 % de adherencia por cuenta de píldoras a los seis meses (RR 0.96, 95 % CI 0.85–1.09, p = 0.51). Los participantes que recibieron terapia motivacional intensiva no mostraron una mayor adherencia al tratamiento o supresión virológica que aquellos bajo terapia didáctica rutinaria. Estos resultados son tranquilizadores ya que muestran que la menos costosa terapia didáctica es adecuada en este escenario.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Francois van Loggerenberg
    • 1
    • 2
    • 3
  • Alison D. Grant
    • 2
  • Kogieleum Naidoo
    • 1
  • Marita Murrman
    • 4
  • Santhanalakshmi Gengiah
    • 1
  • Tanuja N. Gengiah
    • 1
  • Katherine Fielding
    • 5
  • Salim S. Abdool Karim
    • 1
    • 4
  1. 1.CAPRISA, Nelson R Mandela School of MedicineUniversity of KwaZulu-NatalDurbanSouth Africa
  2. 2.Department of Clinical ResearchLondon School of Hygiene and Tropical MedicineLondonUK
  3. 3.The Global Health NetworkCentre for Tropical Medicine, University of OxfordOxfordUK
  4. 4.Mailman School of Public Health, Columbia UniversityNew YorkUSA
  5. 5.Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK

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