[Adherence intervention for HIV-infected patients receiving antiretroviral treatment. Implementation and initial assessment].
OBJECTIVE
To describe the implementation and initial results of a specific educational and counseling intervention to examine and improve adherence to antiretroviral therapy (ARV) in HIV-infected patients.


METHODS
Four patient profiles were defined: 1) discontinuation and 2) failure: patients with virological failure (defined as two consecutive viral loads>200 copies/mL) at ARV discontinuation or under treatment, both seen after the fact; 3) preparation: naive patients seen before starting treatment, and 4) reinforcement: patients in treatment seen for counseling to prevent virological failure. A clinical psychologist, nurse and hospital pharmacist jointly conducted the session. Data collected include standardized information about the characteristics of HIV infection and ARV regimens, and demographic, behavioral, social and cultural indicators. CD4 cell counts and HIV viral loads were recorded at D0, M1, M3, M9 and M12. The effectiveness of the adherence intervention was defined separately for each patient profile based on some combination of taking or restarting an ARV regimen, virological response, and M12 follow-up.


RESULTS
The study included 139 patients between November 1998 and April 2000. The intervention was defined as effective in 50% and 40% of the discontinuation (n=26) and failure (n=61) patients respectively, 84% of those with preparation profile (n=37) and 93% (14/15) of reinforcement patients. Only undetectable HIV viral load at M3 was significantly associated with the effectiveness of the adherence intervention for all 4 profiles. The preventive interventions (preparation and reinforcement) were less effective in patients from outside Europe (p=0.013).


CONCLUSIONS
The adherence intervention was more effective in preventing virological failure than in restoring ARV effectiveness among patients who had already experienced virological failure. It should therefore be proposed primarily before starting ARV, to prevent failure in treatment-naive patients, especially those from outside Europe.
Berki-Benhaddad
Zohra
Z
Service des Maladies Infectieuses et Tropicales B, Groupe Hospitalier Bichat-Claude Bernard, Université Paris VII, Paris.
Ecobichon
Jean-Luc
JL
Mentré
France
F
Capillon
Annie
A
Certain
Agnès
A
Secondi
Catherine
C
Gervais
Anne
A
Longuet
Pascale
P
Vildé
Jean-Louis
JL
Leport
Catherine
C
D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D005602:France; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010349:Patient Compliance; D015397:Program Evaluation; D019562:Viral Load
D044966:Anti-Retroviral Agents