title: Efficacy of a pill-swallowing training intervention to improve antiretroviral medication adherence in pediatric patients with HIV/AIDS.
abstract: OBJECTIVE
  We aimed to retrospectively assess the efficacy of pill-swallowing training provided as a clinical intervention to referred pediatric patients with HIV in relation to improved adherence and subsequent related health outcomes. The primary goal of this study was to demonstrate participation in pill-swallowing training is associated with improved medication adherence as documented by routine pharmacy pill counts. Secondary objectives were to assess corresponding improvements in clinically observed biologic indicators of adherence, specifically, immunologic functioning (CD4+ T-cell%) and viral load, over time.
  
  
  METHODS
  A retrospective chart review of 23 pediatric patients with HIV aged 4 to 21 years who were clinically referred for pill-swallowing training by an experienced pediatric psychologist for either noted difficulties with currently prescribed antiretroviral regimens and/or desire to change the child's regimen/formulary. Patient demographics, reason(s) for pill-swallowing training referral, number of pill-swallowing training sessions required to attain success, adherence, CD4+ T-cell%, and viral load were abstracted at baseline and at approximately 3 and 6 months posttraining.
  
  
  RESULTS
  Modal number of sessions required to acquire the pill-swallowing skill was 1 session. Younger children (aged 4-5 years) required a median of 2 training sessions, while older children required > or = 3 sessions. A significant improvement in adherence from baseline to 6 months post-pill-swallowing training completion was observed, as were significant related improvements in CD4+ T-cell% and viral load.
  
  
  CONCLUSIONS
  Participation in pill-swallowing training related to improved medication adherence at 6 months posttraining. Subsequent improvements in related CD4+ T-cell% and viral load were noted over time, most significantly at 6 months postintervention. These preliminary findings provide justification for additional study via a prospective, randomized, controlled clinical trial. Pill-swallowing training potentially is a successful time-limited, cost-effective intervention to improve adherence to antiretroviral therapies, and thus medical status, in children with HIV.
authors.affiliation: Behavioral Medicine Division, St Jude Children's Research Hospital, 332 N Lauderdale St, Mail Stop 740, Memphis, TN 38105, USA. patti.garvie@stjude.org
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Garvie
authors.forename: Shelly
authors.initials: S
authors.lastname: Lensing
authors.forename: Shesh N
authors.initials: SN
authors.lastname: Rai
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000188:drug therapy; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003679:Deglutition; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods*; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents