title: Effect of a brief antiretroviral adherence intervention delivered by HIV care providers.
abstract: Antiretroviral therapy (ART) is effective in controlling viral load in many people infected with HIV, but high levels of adherence to ART are needed for prolonged viral suppression. This study evaluated a brief adherence intervention delivered to HIV-positive patients by primary care providers during routine medical examinations. Six clinics were randomly allocated to deliver an intervention focusing on ART adherence (2 clinics) or safer sex (4 clinics). Interventions included written information (posters, brochures, and flyers) and brief counseling from providers and were evaluated with cohorts of randomly selected patients (n = 437) measured before and after a 10-month intervention. Among those 95% or greater adherent at baseline, 91% of patients who received the adherence intervention remained 95% or greater adherent at follow-up compared with 75% of the patients who received the safer sex intervention (chi = 12.59, P < 0.01). This difference was significant in a logistic regression analysis (odds ratio = 2.26; 95% confidence interval = 1.27-4.04), adjusting for baseline adherence, demographics, and HIV medical status. The adherence intervention did not significantly increase the prevalence of 95% or greater adherence among patients less than 95% adherent at baseline. Similar but nonsignificant results were observed for viral load. A brief intervention delivered to HIV patients by their primary providers helped to maintain adequate adherence to ART regimens. More intensive intervention is needed to improve adherence among patients who are initially less than 95% adherent.
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. milam@usc.edu
authors.forename: Joel
authors.initials: J
authors.lastname: Milam
authors.forename: Jean L
authors.initials: JL
authors.lastname: Richardson
authors.forename: Allen
authors.initials: A
authors.lastname: McCutchan
authors.forename: Susan
authors.initials: S
authors.lastname: Stoyanoff
authors.forename: Jony
authors.initials: J
authors.lastname: Weiss
authors.forename: Carol
authors.initials: C
authors.lastname: Kemper
authors.forename: Robert A
authors.initials: RA
authors.lastname: Larsen
authors.forename: Harry
authors.initials: H
authors.lastname: Hollander
authors.forename: Penny
authors.initials: P
authors.lastname: Weismuller
authors.forename: Robert
authors.initials: R
authors.lastname: Bolan
mesh_terms: D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D002140:California; D003376:Counseling; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D033181:Information Dissemination; D010349:Patient Compliance / Q000706:statistics & numerical data; D011159:Population Surveillance / Q000379:methods; D015397:Program Evaluation; D021841:Safe Sex / Q000706:statistics & numerical data
chemical_list: D044966:Anti-Retroviral Agents