Journal
HEALTH PSYCHOLOGY
Volume 29, Issue 4, Pages 421-428Publisher
AMER PSYCHOLOGICAL ASSOC
DOI: 10.1037/a0020335
Keywords
patient compliance; adherence; behavioral interventions; randomized controlled trial; HIV
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Objective: To investigated the effectiveness of an adherence intervention (AIMS) designed to fit HIV-clinics' routine care procedures. Design: Through block randomization, patients were allocated to the intervention or control group. The study included 2 months baseline measurement, 3 months intervention, and 4 months follow-up. HIV-nurses delivered a minimal intervention (adherence sustaining) to patients scoring >95% adherence at baseline, and an intensive intervention (adherence improving) to patients with <95% adherence. Control participants received high-quality usual care. Main Outcome Measures: Electronically monitored adherence and viral load. Results: 133 patients were included (67 control, 66 intervention), 60% had <95% adherence at baseline, and 87% (116/133) completed the trial. Intent-to-treat analyses showed that adherence improved significantly in the complete intervention sample. Subgroup analyses showed that this effect was caused by participants scoring <95% at baseline (mean difference = 15.20%; p < .001). These effects remained stable during follow-up. The number of patients with an undetectable viral load increased in the intervention group compared to the control group (OR = 2.96, p < .05). Treatments effects on viral load were mediated by the improvements in adherence. Conclusions: The AIMS-intervention was effective and can be integrated in routine clinical care for HIV-infected patients. Future research should study its (cost)effectiveness among more heterogeneous samples and in settings with variable levels of standard care.
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