title: Community HIV treatment advocacy programs may support treatment adherence.
abstract: Treatment advocacy (TA) programs, based in AIDS service organizations and clinics, aim to engage clients into care and support antiretroviral treatment (ART) adherence through client-centered counseling; advocate for patients with providers; and provide social service referrals. Systematic evaluations of TA are lacking. We conducted a non-randomized evaluation examining relationships of TA participation to adherence, care engagement, social services utilization, unmet needs, patient self-advocacy, and adherence self-efficacy among 121 HIV-positive clients (36 in TA, 85 not in TA; 87% male, 34% African American, 31% White, 19% Latino). In multivariate models, TA participants (vs. non-TA participants) showed higher electronically monitored [85.3% vs. 70.7% of doses taken; b(SE) = 13.16(5.55), p < .05] and self-reported [91.1% vs. 75.0%; b(SE) = 11.60(5.65), p < .05] adherence; utilized more social service programs [Ms = 5.2 vs. 3.4; b(SE) = 1.97(0.48), p < .0001]; and had fewer unmet social-service needs [Ms = 1.8 vs. 2.7; b(SE) = -1.06(0.48), p < .05]. Findings suggest the need for a randomized controlled trial of TA.
authors.affiliation: Division of General Pediatrics, Children's Hospital Boston, Boston, MA 02115, USA. laura.bogart@childrens.harvard.edu
authors.forename: Laura M
authors.initials: LM
authors.lastname: Bogart
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Wagner
authors.forename: Matt G
authors.initials: MG
authors.lastname: Mutchler
authors.forename: Brian
authors.initials: B
authors.lastname: Risley
authors.forename: Bryce W
authors.initials: BW
authors.lastname: McDavitt
authors.forename: Tara
authors.initials: T
authors.lastname: McKay
authors.forename: David J
authors.initials: DJ
authors.lastname: Klein
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000628:therapy; D000328:Adult; D003153:Community Health Services; D003376:Counseling / Q000706:statistics & numerical data*; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D010344:Patient Advocacy; D010358:Patient Participation / Q000706:statistics & numerical data; D011050:Policy Making; D015397:Program Evaluation; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D016903:Drug Monitoring