title: Sustained benefit from a long-term antiretroviral adherence intervention. Results of a large randomized clinical trial.
abstract: OBJECTIVE
  To assess the efficacy of 2 adherence interventions, medication managers (MM) and medication alarms (ALR), among antiretroviral (ARV)-naive persons with HIV initiating ARV therapy.
  
  
  METHODS
  A multicenter, randomized, adherence intervention clinical trial was conducted among participants coenrolled in an HIV ARV strategy study for ARV-naive individuals. Sites were assigned by cluster randomization using a 2 x 2 factorial design to administer MM, ALR, MM + ALR, or neither (control). MM participants received individualized, structured, long-term adherence support from trained MMs. ALR participants received individually programmed ALR alarms for use throughout the study.
  
  
  RESULTS
  The 928 participants, followed a median of 30 months, included 22% women and 75% nonwhites; the median baseline CD4 count was 155 cells/mm. First virologic failure was 13% lower in all MM versus no-MM groups (P = 0.13) and 28% lower in MM versus no-MM subgroups randomized to 2-class ARV arms in the parent ARV study (P = 0.01). MM (vs. no-MM) participants had significantly better CD4 cells count (P = 0.01) and adherence (P < 0.001) outcomes. ALR (vs. no-ALR) participants had worse virologic outcomes.
  
  
  CONCLUSIONS
  This large randomized clinical trial demonstrated that interpersonal structured adherence support was associated with improved long-term medication adherence and virologic and immunologic HIV outcomes.
authors.affiliation: Harlem Hospital and Columbia University College of Physicians and Surgeons, New York, NY 10037, USA. sbm20@columbia.edu
authors.forename: Sharon B
authors.initials: SB
authors.lastname: Mannheimer
authors.forename: Edward
authors.initials: E
authors.lastname: Morse
authors.forename: John P
authors.initials: JP
authors.lastname: Matts
authors.forename: Laurie
authors.initials: L
authors.lastname: Andrews
authors.forename: Carroll
authors.initials: C
authors.lastname: Child
authors.forename: Barry
authors.initials: B
authors.lastname: Schmetter
authors.forename: Gerald H
authors.initials: GH
authors.lastname: Friedland
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance
chemical_list: D019380:Anti-HIV Agents