Electronic monitoring-based counseling to enhance adherence among HIV-infected patients: a randomized controlled trial.
OBJECTIVE
To investigated the effectiveness of an adherence intervention (AIMS) designed to fit HIV-clinics' routine care procedures.


METHODS
Through block randomization, patients were allocated to the intervention or control group. The study included 2 months baseline measurement, 3 months intervention, and 4 months follow-up. HIV-nurses delivered a minimal intervention ("adherence sustaining") to patients scoring >95% adherence at baseline, and an intensive intervention ("adherence improving") to patients with <95% adherence. Control participants received high-quality usual care.


METHODS
Electronically monitored adherence and viral load.


RESULTS
133 patients were included (67 control, 66 intervention), 60% had <95% adherence at baseline, and 87% (116/133) completed the trial. Intent-to-treat analyses showed that adherence improved significantly in the complete intervention sample. Subgroup analyses showed that this effect was caused by participants scoring <95% at baseline (mean difference = 15.20%; p < .001). These effects remained stable during follow-up. The number of patients with an undetectable viral load increased in the intervention group compared to the control group (OR = 2.96, p < .05). Treatments effects on viral load were mediated by the improvements in adherence.


CONCLUSIONS
The AIMS-intervention was effective and can be integrated in routine clinical care for HIV-infected patients. Future research should study its (cost)effectiveness among more heterogeneous samples and in settings with variable levels of standard care.
de Bruin
Marijn
M
Department Work and Social Psychology, Maastricht University. Marijn, Amsterdam. debruin@wur.nl
Hospers
Harm J
HJ
van Breukelen
Gerard J P
GJ
Kok
Gerjo
G
Koevoets
William M
WM
Prins
Jan M
JM
D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003376:Counseling; D016903:Drug Monitoring / Q000295:instrumentation*; D004349:Drug Packaging / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010349:Patient Compliance / Q000706:statistics & numerical data*; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
D044966:Anti-Retroviral Agents