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Effects of Counselling on Adherence to Antiretroviral Treatment Among People with HIV in Estonia: A Randomized Controlled Trial

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Abstract

To assess the efficacy of an education- and strengths-based counselling programme to promote antiretroviral therapy (ART) adherence in a cohort of HIV-infected individuals with high prevalence of injection drug use in Estonia. Parallel-group randomized (1:1) controlled trial (RCT). Adults receiving ART in two clinics were followed for 12 months. The trial compared: (i) an intervention (three sessions) incorporated into routine clinic visits, providing education about HIV, ART, the role of adherence, and tailoring regimen to daily routines using problem-solving skills to address adherence barriers versus (ii) usual care (control). Primary and secondary outcomes were self-reported ART adherence (3-day recall) and viral load (respectively). 519 patients were randomized and 82% completed the study. Recent optimal ART adherence (3-day recall ≥95%) was reported by 75.6% in the intervention group and 72.9% of controls at baseline and 76.7% and 67.5%, respectively, at 12 months (RR 1.14, 95% CI 1.00–1.28; adjusted RR 1.13, 95% CI 1.00–1.27). There was no difference in the proportion of patients with undetectable viral load. At 12 months the intervention group reported significantly higher perceptions of ART necessity versus ART concerns [mean ART necessity-concerns differential: intervention group 1.32 (SD 1.22) vs control group 1.08 (SD 1.12); p = 0.048]. All-cause mortality among study participants was 27.7 per 1000 person years (95% CI 15.6–44.8). A brief, clinic-based adherence intervention alone may assist with adherence but lacks impact on viral load at 12 months.

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Acknowledgements

This work was supported by the European Union through the European Regional Development Fund within the research project „Bridging the gap in knowledge and practice of prevention and care for HIV in Estonia” (HIV-BRIDGE), and by Grant # TARTH15017I from the Estonian Ministry of Education and Research.

Collaborators for the HIV-BRIDGE Study Group

Dr Kai Zilmer, dr Tiiu Aug, dr Kerstin Kase, dr Helen Mülle, dr Kersti Kink, Merike Meindok, Irina Milaševitš, Irina Sorokina, Olev Lumiste ja Liudmila Ponomarenko at the West Tallinn Central Hospital; and dr Jelena Šmidt, dr Svetlana Semjonova, dr Natalia Nikitina, dr Julia Kogan, Anne Junolainen, Marjana Golubnitšija ja Tatiana Fishkova at the Ida-Viru Central Hospital (Kohtla-Järve).

Author information

Authors and Affiliations

  1. Department of Family Medicine and Public Health, University of Tartu, Ravila St 19, 50411, Tartu, Estonia

    Anneli Uusküla, Kaja-Triin Laisaar, Mait Raag & Liis Lemsalu

  2. Infectious Diseases and Drug Monitoring Department, National Institute for Health Development, Hiiu St 42, Tallinn, Estonia

    Liis Lemsalu, Liilia Lõhmus & Kristi Rüütel

  3. School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA

    K. Rivet Amico

Authors
  1. Anneli Uusküla
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  2. Kaja-Triin Laisaar
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  7. K. Rivet Amico
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Consortia

HIV-BRIDGE Study Group

  • Kai Zilmer
  • , Tiiu Aug
  • , Kerstin Kase
  • , Helen Mülle
  • , Kersti Kink
  • , Merike Meindok
  • , Irina Milaševitš
  • , Irina Sorokina
  • , Olev Lumiste ja Liudmila Ponomarenko
  • , Jelena Šmidt
  • , Svetlana Semjonova
  • , Natalia Nikitina
  • , Julia Kogan
  • , Anne Junolainen
  •  & Marjana Golubnitšija ja Tatiana Fishkova

Contributions

AU, KTL and RA had the original idea for the article and outlined the design. KTL and KR were responsible for data collection, LL for data management; MR for data analysis. AU wrote the first draft of the manuscript to which all other authors contributed.

Corresponding author

Correspondence to Anneli Uusküla.

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Conflict of interest

The authors report no conflict of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Collaborators of the HIV-BRIDGE Study Group is listed in “Acknowledgment”.

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Uusküla, A., Laisaar, KT., Raag, M. et al. Effects of Counselling on Adherence to Antiretroviral Treatment Among People with HIV in Estonia: A Randomized Controlled Trial. AIDS Behav 22, 224–233 (2018). https://doi.org/10.1007/s10461-017-1859-6

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