Prospective, randomized, two-arm controlled study to evaluate two interventions to improve adherence to antiretroviral therapy in Spain.
BACKGROUND
Proper adherence is essential to obtain the desired results of antiretroviral therapy; thus, new interventional strategies for this purpose must be sought.


OBJECTIVE
Comparison of 2 interventions, one conducted by a health professional and the other by a peer (patient on antiretroviral therapy), to improve adherence to antiretroviral therapy.


METHODS
In 2003, a randomized, concurrent, follow-up study was conducted at 3 hospitals.


METHODS
Patients were recruited consecutively at infectious disease visits scheduled to monitor their disease from May to September 2003. A sealed envelope was used to assign patients to each intervention group. A previous phase was conducted to unify data collection, and the intervention consisted of 4 visits at weeks 0, 8, 16, and 24.


RESULTS
Among the 240 patients included, 198 completed follow-up, and in 11 of these, treatment was interrupted at the doctor's decision. At baseline, 46.8% were classified as adherent. Multilevel analysis showed that as the visits progressed, the probability of adhering to treatment increased (OR 1.23; P<.01). Although differences were not significant, the group treated by a peer showed better results than the group treated by a health professional (OR 1.60; P=0.25). A lower probability of antiretroviral adherence was observed in patients receiving a drug combination including a protease inhibitor (OR 0.27; P<0.01) and in those with psychological distress (OR 0.44; P=0.03). Patients with a higher score on the physical quality of life index (OR 1.05; P<0.01) presented a higher probability of adherence.


CONCLUSIONS
The psychoeducational intervention studied is viable and effective for improving antiretroviral adherence. When the intervention is conducted by a peer the results are at least as good as those obtained by a health professional, and this implies cost-saving for the health system.
Ruiz
Isabel
I
Andalusian School of Public Health, Granada, Spain. isabel.ruiz.easp@juntadeandalucia.es
Olry
Antonio
A
López
Miguel Angel
MA
Prada
José Luis
JL
Causse
Miguel
M
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010379:Peer Group; D011446:Prospective Studies; D013030:Spain; D016903:Drug Monitoring
D044966:Anti-Retroviral Agents