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Patient Activation and Improved Outcomes in HIV-Infected Patients



The Patient Activation Measure (PAM) assesses several important concepts in chronic care management, including self-efficacy for positive health behaviors. In HIV-infected populations, better self-efficacy for medication management is associated with improved adherence to antiretroviral medications (ARVs), which is critically important for controlling symptoms and slowing disease progression.


To determine 1) characteristics associated with patient activation and 2) associations between patient activation and outcomes in HIV-infected patients.


Cross-sectional survey.


433 patients receiving care in four HIV clinics.


An interviewer conducted face-to-face interviews with patients following their HIV clinic visit. Survey data were supplemented with medical record abstraction to obtain most recent CD4 counts, HIV viral load and antiretroviral medications.


Patient activation was measured using the 13-item PAM (possible range 0–100). Outcomes included CD4 cell count > 200 cells/mL3, HIV-1 RNA < 400 copies/mL (viral suppression), and patient-reported adherence.


Overall, patient activation was high (mean PAM = 72.3 [SD 16.5, range 34.7–100]). Activation was lower among those without vs. with a high school degree (68.0 vs. 74.0, p < .001), and greater depression (77.6 lowest, 70.2 middle, 68.1 highest tertile, p < .001). There was no association between patient activation and age, race, gender, problematic alcohol use, illicit drug use, or social status. In multivariable models, every 5-point increase in PAM was associated with greater odds of CD4 count > 200 cells/mL3 (aOR 1.10 [95 % CI 1.01, 1.21]), adherence (aOR 1.18 [95 % CI 1.09, 1.29]) and viral suppression (aOR 1.08 [95 % CI 1.00, 1.17]). The association between PAM and viral suppression was mediated through adherence.


Higher patient activation was associated with more favorable HIV outcomes. Interventions to improve patient activation should be developed and tested for their ability to improve HIV outcomes.

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All authors who contributed to the manuscript meet the criteria for authorship.


This research was supported by a contract from the Health Resources Service Administration and the Agency for Healthcare Research and Quality (AHRQ 290-01-0012). Dr. Korthuis’ time was supported by the National Institutes of Health, National Institute on Drug Abuse (K23DA019809). Dr. Beach was supported by the Agency for Healthcare Research and Quality (K08 HS013903-05), and both Dr. Beach and Dr. Saha were supported by Robert Wood Johnson Generalist Physician Faculty Scholars Awards. Dr. Saha is supported by the Department of Veterans Affairs. The contents of the publication are solely the responsibility of the authors and do not necessarily represent the views of the funding agencies or the U.S. government.

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The authors declare that they do not have a conflict of interest.

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Correspondence to P. Todd Korthuis MD, MPH.

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Marshall, R., Beach, M.C., Saha, S. et al. Patient Activation and Improved Outcomes in HIV-Infected Patients. J GEN INTERN MED 28, 668–674 (2013).

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  • patient activation
  • HIV
  • self-efficacy
  • medication adherence
  • patient outcomes