A 2-arm, randomized, controlled trial of a motivational interviewing-based intervention to improve adherence to antiretroviral therapy (ART) among patients failing or initiating ART.
OBJECTIVE
Motivational interviewing (MI) is a counseling technique that has been used effectively to change a number of health-related behaviors. We sought to assess the impact on patients' antiretroviral therapy (ART) adherence of a multicomponent, MI-based ART adherence intervention compared with that of an HIV informational control program.


METHODS
Two-arm, randomized, controlled trial.


METHODS
One hundred forty adult HIV-infected patients attending a large, academic center infectious diseases clinic who were either failing or newly initiating an ART regimen. STUDY ENDPOINTS: (1) Mean adherence level (% of prescribed doses take in the prior month) at the week 12 visit, (2) change in mean adherence, (3) percentage of patients achieving >95% adherence in the third 4-week block, and (4) change in viral load.


RESULTS
The MI group's mean adherence improved by 4.5% compared with a decrease in the control group's adherence by 3.83% (P = 0.10). In the treatment group, 29% achieved >95% adherence compared with only 17% in the control group (P = 0.13). When we controlled for ethnicity, the intervention group had 2.75 times higher odds of achieving more than 95% adherence than did the controls (P = 0.045; 95% confidence interval: 1.023, 7.398). Although a number of mediating variables (beliefs about ART, coping style, social support, and goals set) had statistically significant changes in the expected direction in the MI group compared with controls, in the intent-to-treat analysis, the mean adherence at study exit for the intervention group was 76% (SD = 27%) and 71% (SD = 27%) for the control group (P = 0.62).


CONCLUSIONS
Although not definitive, this study provides some evidence that MI offers an effective approach to improving adherence. Future studies able to build MI into the intervention for longer than 3 months may have a greater impact.
Golin
Carol E
CE
Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7590, USA. Carol_Golin@unc.edu
Earp
Joanne
J
Tien
Hsiao-Chuan
HC
Stewart
Paul
P
Porter
Carol
C
Howie
Lynn
L
D000046:Academic Medical Centers; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D037001:Directive Counseling; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D015497:HIV-1; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009042:Motivation; D010349:Patient Compliance; D015397:Program Evaluation; D017211:Treatment Failure; D016312:Treatment Refusal; D019562:Viral Load
D044966:Anti-Retroviral Agents