A randomized controlled trial to enhance antiretroviral therapy adherence in patients with a history of alcohol problems

To assess the effectiveness of an individualized multicomponent intervention to promote adherence to antiretroviral therapy (ART) in a cohort of HIV-infected individuals with a history of alcohol problems. We conducted a randomized controlled trial to compare the usual medical follow-up with an adhe...

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Veröffentlicht in:Antiviral therapy 2005, Vol.10 (1), p.83-93
Hauptverfasser: SAMET, Jeffrey H, HORTON, Nicholas J, MELI, Seville, DUKES, Kim, TRIPP, Tara, SULLIVAN, Lisa, FREEDBERG, Kenneth
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Sprache:eng
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Zusammenfassung:To assess the effectiveness of an individualized multicomponent intervention to promote adherence to antiretroviral therapy (ART) in a cohort of HIV-infected individuals with a history of alcohol problems. We conducted a randomized controlled trial to compare the usual medical follow-up with an adherence intervention. The principal enrolment site was Boston Medical Center, a private, not-for-profit, academic medical institution. HIV-infected patients with a history of alcohol problems on ART. A total of 151 were enrolled and 141 (93%) were assessed at follow-up. A nurse, trained in motivational interviewing, completed the following over 3 months in four encounters: addressed alcohol problems; provided a watch with a programmable timer to facilitate pill taking; enhanced perception of treatment efficacy; and delivered individually tailored assistance to facilitate medication use. Prior 30-day adherence > or =95%, prior 3-day adherence of 100%, CD4 cell count, HIV RNA and alcohol consumption, each at both short- and long-term follow-up. At follow-up, no significant differences in medication adherence, CD4 cell count, HIV RNA or alcohol consumption were found (all P values >0.25). A multicomponent intervention to enhance adherence among HIV-infected individuals with a history of alcohol problems was not associated with changes in medication adherence, alcohol consumption or markers of HIV disease progression. The failure to change adherence in a group at high risk for poor adherence, despite utilizing an intensive individual-focused patient intervention, supports the idea of addressing medication adherence with supervised medication delivery or markedly simplified dosing regimens.
ISSN:1359-6535
2040-2058
DOI:10.1177/135965350501000106