Friday, 14 January 2005 - 10:00 AM

This presentation is part of: HIV Prevention and Treatment

Adding precision to theory-based, medication adherence support interventions in HIV infection

Background: Non-adherence to antiretroviral therapy (ART) is common in the clinical care of people with human immunodeficiency virus type-1 (HIV) infection. Mediators of non-adherence to ART can be difficult to identify, measure and modify in order to effectively intervene and prevent HIV disease progression. The objective of this study was to compare the association of informal (I) and formal (F) Stage of Change (SOC) adherence measures with HIV suppression over time. Methods: Women enrolled in an adherence program at an HIV comprehensive care center received peer-delivered support matched to SOC for ART adherence based on the Transtheoretical Model of Health Behavior Change (TTM). F-SOC scores taken from the adherence questionnaire were matched to I-SOC scores from the care team weekly adherence meetings (+14 days). The paired SOC was compared to interval change in HIV biological outcomes. Results: Among 116 participants (pts), there were 342 available SOC pairs with linked biological outcomes over time. The mean age of the pts was 33 years (18-62 yrs), 101 (83%) were African American, 23 (19%) reported domestic violence, 30 (25%) reported substance use, 67 (55%) presented with mental illness, 11 (10%) were ART-naïve, 5 (4%) were pregnant and the mean nadir CD4 count was 158 cells/mm3 (range 0- 827). There was 64% concurrence between the team-derived I-SOC and self-reported F-SOC with F-SOC (and I-SOC) pairs of 28 (73) in Precontemplation, 47 (32) in Contemplation, 68 (39) in Preparation, 107 (115) in Action, and 96 (87) in Maintenance. The team staged 27% of the pts in earlier SOC and 9% in later SOC for ART adherence than the pt self-reported F-SOC. I-SOC showed stronger correlation (r = -.408, p <.01) than F-SOC (r= - 0.279, p < 0.01) for association with HIV suppression (bivariate outcome of < 400 copies/ml.). Conclusions: The addition of I-SOC was effectively incorporated into weekly multidisciplinary adherence support meetings. The real-time use of I-SOC, com pared to F-SOC, added precision to peer-delivery of tailored, stage-matched interventions and showed stronger correlation with HIV suppression. Implications for practice: It is possible to replicate or modify this adherence support model at other HIV/AIDS clinical care settings. In translating this theory-based research model of ART adherence into practice, this multidisciplinary approach has the potential of contributing to HIV suppression, immune reconstitution, quality of life, HIV-related survival, and prevention of drug-resistant HIV infection.

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