Efficacy of an individualized adherence support program with contingent reinforcement among nonadherent HIV-positive patients: results from a randomized trial.
OBJECTIVE
To evaluate the efficacy of a program designed to improve adherence to antiretroviral therapy among patients with poor adherence.


METHODS
A randomized intervention trial was conducted among 90 HIV-positive patients experiencing treatment failure as a result of noncompliance with their medication regimen. Eligible participants were randomly assigned to an adherence case management intervention with monetary reinforcement (CM) or to a standard of care group (SC). The CM participants met regularly with a treatment advocate for individualized adherence support. Efficacy was measured in terms of reductions in viral load and improvements in immune function at weeks 12, 24, and 48.


RESULTS
After 48 weeks, 55% (n=26) of those in the CM achieved at least a 1-log10 drop in viral load as compared to 28% (n=12) in the SC group (P=.0089). Furthermore, the mean CD4 count was 209 cells/mm3 for the CM group as compared to 150 cells/mm3 in the SC group (P=.0333). Based on logistic regression analysis, being in the CM was an independent predictor of reduction in viral load (odds ratio=2.49; P=.0514).


CONCLUSIONS
The individualized adherence intervention is feasible and effective in reducing viral load and improving immune function.
Javanbakht
Marjan
M
AIDS Healthcare Foundation, 2615 South Grand Avenue, Room 500, Los Angeles, CA 90007, USA. javan@ucla.edu
Prosser
Paul
P
Grimes
Tim
T
Weinstein
Michael
M
Farthing
Charles
C
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology* / Q000821:virology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D016312:Treatment Refusal
D019380:Anti-HIV Agents; D012367:RNA, Viral