Couple-focused support to improve HIV medication adherence: a randomized controlled trial.
OBJECTIVE
To assess the efficacy of a couple-based intervention to improve medication-taking behavior in a clinic population with demonstrated adherence problems.


METHODS
A randomized controlled trial (SMART Couples Study) conducted between August 2000 and January 2004.


METHODS
Two HIV/AIDS outpatient clinics in New York City.


METHODS
Heterosexual and homosexual HIV-serodiscordant couples (n = 215) in which the HIV-seropositive partner had < 80% adherence at baseline. The sample was predominantly lower-income racial/ethnic minorities.


METHODS
Participants were randomly assigned to a four-session couple-focused adherence intervention or usual care. The intervention consisted of education about treatment and adherence, identifying adherence barriers, developing communication and problem-solving strategies, optimizing partner support, and building confidence for optimal adherence.


METHODS
Medication adherence at week 8 (2 weeks after the intervention) compared with baseline, assessed with a Medication Event Monitoring System cap.


RESULTS
Intervention participants showed higher mean medication adherence at post-intervention when compared with controls whether adherence was defined as proportion of prescribed doses taken (76% versus 60%) or doses taken within specified time parameters (58% versus 35%). Also, participants in the intervention arm were significantly more likely to achieve high levels of adherence (> 80%, > 90%, or > 95%) when compared with controls. However, in most cases, effects diminished with time, as seen at follow-up at 3 and 6 months.


CONCLUSIONS
The SMART Couples program significantly improved medication adherence over usual care, although the level of improved adherence, for many participants, was still suboptimal and the effect was attenuated over time.
Remien
Robert H
RH
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York 10032, USA. rhr1@columbia.edu
Stirratt
Michael J
MJ
Dolezal
Curtis
C
Dognin
Joanna S
JS
Wagner
Glenn J
GJ
Carballo-Dieguez
Alex
A
El-Bassel
Nabila
N
Jung
Tiffany M
TM
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006716:Homosexuality; D006801:Humans; D008297:Male; D009519:New York City; D010349:Patient Compliance; D010353:Patient Education as Topic; D012747:Sexual Partners; D012944:Social Support