title: A randomized controlled trial to enhance antiretroviral therapy adherence in patients with a history of alcohol problems.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  We conducted a randomized controlled trial to compare the usual medical follow-up with an adherence intervention.
  
  
  METHODS
  The principal enrolment site was Boston Medical Center, a private, not-for-profit, academic medical institution.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  At follow-up, no significant differences in medication adherence, CD4 cell count, HIV RNA or alcohol consumption were found (all P values >0.25).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University Schools of Medicine and Public Health, Boston, MA, USA. jsamet@bu.edu
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Horton
authors.forename: Seville
authors.initials: S
authors.lastname: Meli
authors.forename: Kim
authors.initials: K
authors.lastname: Dukes
authors.forename: Tara
authors.initials: T
authors.lastname: Tripps
authors.forename: Lisa
authors.initials: L
authors.lastname: Sullivan
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications* / Q000523:psychology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001521:Behavior Therapy; D001900:Boston; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents