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Computer-Based Intervention in HIV Clinical Care Setting Improves Antiretroviral Adherence: The LifeWindows Project

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Abstract

We evaluated the efficacy of LifeWindows, a theory-based, computer-administered antiretroviral (ARV) therapy adherence support intervention, delivered to HIV + patients at routine clinical care visits. 594 HIV + adults receiving HIV care at five clinics were randomized to intervention or control arms. Intervention vs. control impact in the intent-to-treat sample (including participants whose ARVs had been entirely discontinued, who infrequently attended care, or infrequently used LifeWindows) did not reach significance. Intervention impact in the On Protocol sample (328 intervention and control arm participants whose ARVs were not discontinued, who attended care and were exposed to LifeWindows regularly) was significant. On Protocol intervention vs. control participants achieved significantly higher levels of perfect 3-day ACTG-assessed adherence over time, with sensitivity analyses maintaining this effect down to 70% adherence. This study supports the utility of LifeWindows and illustrates that patients on ARVs who persist in care at clinical care sites can benefit from adherence promotion software.

Resumen

Evaluamos la eficacia de LifeWindows, una intervención de apoyo para la adherencia a la terapia antirretroviral (TAR) basada en teoría y con administración informatizada para pacientes con VIH + en sus visitas clínicas rutinarias. 594 adultos de cinco clínicas con VIH + y bajo tratamiento fueron aleatoriamente asignados a un grupo de intervención o de control. No se alcanzó significación estadística al comparar ambos grupos bajo la estrategia de ‘intención de tratar’ (incluyendo los participantes cuyos TAR se habían interrumpido por completo, habían asistido a la clínica en pocas ocasiones, o usaron LifeWindows con poca frecuencia). Sin embargo, la intervención obtuvo un impacto significativo cuando se evaluó con la muestra bajo Protocolo (un total de 328 participantes cuyos TAR no fueron interrumpidos, asistieron a sus visitas clínicas y se expusieron a LifeWindows regularmente). Los participantes bajo Protocolo de intervención obtuvieron niveles más altos de adherencia que el grupo control en tres días de Estudios de Grupos Clinicos con SIDA (EGCS) con repetidas evaluaciones y manteniendo como mínimo un 70% de la adherencia. Este estudio apoya la utilidad de LifeWindows e indica que los pacientes con TAR que asisten a las visitas clínicas, pueden beneficiarse de este software de promoción de la adherencia.

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Notes

  1. Assays varied between clinics and also within clinics over time. In order to equalize results from assays of varying sensitivity, we selected the highest minimum-detection threshold used (HIV-1 RNA ≤ 400 copies/ml) to define "undetectable" viral load.

  2. Adherence assessments were not conducted at visits where patients' medical records indicated complete discontinuation of all ARVs.

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Acknowledgment

This study was funded by a National Institute of Mental Health grant (5 R01 MH066684), Jeffrey D. Fisher, Principal Investigator.

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Authors and Affiliations

  1. Department of Psychology, University of Connecticut, Storrs, CT, USA

    Jeffrey D. Fisher

  2. Center for Health, Intervention, and Prevention (CHIP), University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269-1248, USA

    Jeffrey D. Fisher, K. Rivet Amico, Deborah H. Cornman, Caroline Redding & William Barta

  3. Departments of Psychology and Obstetrics and Gynecology, University of Western Ontario, London, ON, Canada

    William A. Fisher

  4. Centre for Addiction and Mental Health, Toronto, ON, Canada

    Paul A. Shuper & Cynthia Trayling

  5. Department of Psychology, University of Toronto, Toronto, ON, Canada

    Paul A. Shuper

  6. School of Natural and Social Sciences, Purchase College, State University of New York, Purchase, NY, USA

    Anthony F. Lemieux

  7. AIDS Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Frederick L. Altice & Gerald Friedland

  8. University of Connecticut Health Center, Farmington, CT, USA

    Kevin Dieckhaus

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  1. Jeffrey D. Fisher
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for the LifeWindows Team

Corresponding author

Correspondence to Jeffrey D. Fisher.

Additional information

This article was written on behalf of the LifeWindows Team. The members of the team and their contributions appear in the Appendix.

Appendix

Appendix

The LifeWindows Team contributions and contributors:

Study concept and design

Frederick L. Altice, MD, K. Rivet Amico, PhD, William Barta, PhD, Deborah H. Cornman, PhD, Kevin Diekhaus, MD, Rebecca A. Ferrer, PhD, Jeffrey D. Fisher, PhD, William A. Fisher, PhD, Gerald Friedland, MD, Anthony F. Lemieux, PhD, Wynne Norton, PhD, David Portnoy, PhD, Caroline Redding, MSR, Paul A. Shuper, PhD, Zoe Strickler, Cynthia Trayling.

Acquisition of data

Kevin Dieckhaus, MD, Gerald Friedland, MD, Caroline Redding, MSR, Jack Ross, MD, Cynthia Trayling, Richard Colon, Merceditas Villanueva, MD, Krystn Wagner, MD, PhD, Sharon Weissman, MD.

Analysis and interpretation of data

Frederick L. Altice, MD, K. Rivet Amico, PhD, Deborah H. Cornman, PhD, Jeffrey D. Fisher, PhD, William A. Fisher, PhD, Paul A. Shuper, PhD.

Drafting of the manuscript

K. Rivet Amico, PhD, Jeffrey D. Fisher, PhD, William A. Fisher, PhD, Paul A. Shuper, PhD, Cynthia Trayling.

Critical revision of the manuscript for important intellectual content

Frederick L. Altice, MD, K. Rivet Amico, PhD, Deborah H. Cornman, PhD, Jeffrey D. Fisher, PhD, William A. Fisher, PhD, Gerald Friedland, MD, Paul A. Shuper, PhD.

Statistical analysis

K. Rivet Amico, PhD.

Obtained funding

Frederick L. Altice, MD, K. Rivet Amico, PhD, Deborah H. Cornman, PhD, Jeffrey D. Fisher, PhD, William A. Fisher, PhD.

Administrative, technical, or material support

K. Rivet Amico, PhD, William Barta, PhD, Deborah H. Cornman, PhD, Rebecca Ferrer, Ph.D, Jeffrey D. Fisher, Anthony F. Lemieux, PhD, Wynne Norton, PhD, Caroline Redding, MSR, Paul A. Shuper, PhD, Cynthia Trayling, Richard Colon.

Study supervision

Frederick L. Altice, MD, K. Rivet Amico, PhD, Deborah H. Cornman, PhD, Kevin Dieckhaus, MD, Jeffrey D. Fisher, PhD, Gerald Friedland, MD, Caroline Redding, MSR, Jack Ross, MD, Paul A. Shuper, PhD, Cynthia Trayling, Richard Colon, Merceditas Villanueva, MD, Krystn Wagner, MD, Sharon Weissman, MD.

Additional Contributions

We thank the following individuals for helping us collect the viral load data: Michael Kozal, Shaili Gupta, Laurie Andrews and Randi Garcia. Also, we are greatly appreciative of the efforts of the on-site LifeWindows assistants who assisted patients on a daily basis throughout the project, including Margarita Garcia, Timothy Gorin, Alfred Guante, Taber Murphy-Dizon, Chris Richie, Mathew Tochtenhagen, and Barbara Valdez. Erin Lenz helped us in the preparation of this manuscript.

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Fisher, J.D., Amico, K.R., Fisher, W.A. et al. Computer-Based Intervention in HIV Clinical Care Setting Improves Antiretroviral Adherence: The LifeWindows Project. AIDS Behav 15, 1635–1646 (2011). https://doi.org/10.1007/s10461-011-9926-x

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