Randomized controlled trial of an intervention to prevent adherence failure among HIV-infected patients initiating antiretroviral therapy.
OBJECTIVE
Compare the efficacy of a multicomponent social support intervention to standard-of-care counseling on medication adherence among HIV-infected patients initiating antiretroviral therapy.


METHODS
Randomized controlled trial. Generalized estimating equations tested for differences in the percentage of participants achieving 90% adherence.


METHODS
Pill-taking, electronically monitored over 6 consecutive months; plasma viral load (VL), assessed at 3 and 6 months following initiation of therapy.


RESULTS
Of 226 participants who were randomized and began the trial, 87 (38%) were lost to the study by 6 months. The proportion of adherent participants declined steadily over time, with no time by group interaction. Sustained adherence was associated with increased odds of achieving an undetectable VL (OR=1.78; 95% CI=1.01, 3.13). In intention-to-treat analyses, a larger proportion of the intervention group than the control group was adherent (40.15% vs. 27.59%, p=.02) and achieved an undetectable VL p=.04). However, the majority of participants who remained on study experienced some reduction in VL (>or=1-log drop or undetectable), regardless of experimental condition.


CONCLUSIONS
The multicomponent social support intervention significantly improved medication adherence over standard-of-care counseling; evidence for improved virologic outcomes was inconsistent. Early discontinuation of care and treatment may be a greater threat to the health of HIV patients than imperfect medication-taking.
Koenig
Linda J
LJ
Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA 30033, USA. lek5@cdc.gov
Pals
Sherri L
SL
Bush
Tim
T
Pratt Palmore
Melody
M
Stratford
Dale
D
Ellerbrock
Tedd V
TV
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D003131:Combined Modality Therapy; D004349:Drug Packaging; D005260:Female; D005500:Follow-Up Studies; D005845:Georgia; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology* / Q000821:virology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D012944:Social Support; D016312:Treatment Refusal / Q000523:psychology*; D014505:Urban Population; D019562:Viral Load