title: A randomized controlled trial examining the efficacy of motivational counseling with observed therapy for antiretroviral therapy adherence.
abstract: This study determined whether motivational interviewing-based cognitive behavioral therapy (MI-CBT) adherence counseling combined with modified directly observed therapy (MI-CBT/mDOT) is more effective than MI-CBT counseling alone or standard care (SC) in increasing adherence over time. A three-armed randomized controlled 48-week trial with continuous electronic drug monitored adherence was conducted by randomly assigning 204 HIV-positive participants to either 10 sessions of MI-CBT counseling with mDOT for 24 weeks, 10 sessions of MI-CBT counseling alone, or SC. Poisson mixed effects regression models revealed significant interaction effects of intervention over time on non-adherence defined as percent of doses not-taken (IRR = 1.011, CI = 1.000-1.018) and percent of doses not-taken on time (IRR = 1.006, CI = 1.001-1.011) in the 30 days preceding each assessment. There were no significant differences between groups, but trends were observed for the MI-CBT/mDOT group to have greater 12 week on-time and worse 48 week adherence than the SC group. Findings of modest to null impact on adherence despite intensive interventions highlights the need for more effective interventions to maintain high adherence over time.
authors.affiliation: HIV Research Group, Department of Psychology, University of Missouri-Kansas City, 5030 Cherry Street, Ste 310, Kansas City, MO 64110, USA. goggink@umkc.edu
authors.forename: Kathy
authors.initials: K
authors.lastname: Goggin
authors.forename: Mary M
authors.initials: MM
authors.lastname: Gerkovich
authors.forename: Karen B
authors.initials: KB
authors.lastname: Williams
authors.forename: Julie W
authors.initials: JW
authors.lastname: Banderas
authors.forename: Delwyn
authors.initials: D
authors.lastname: Catley
authors.forename: Jannette
authors.initials: J
authors.lastname: Berkley-Patton
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Wagner
authors.forename: James
authors.initials: J
authors.lastname: Stanford
authors.forename: Sally
authors.initials: S
authors.lastname: Neville
authors.forename: Vinutha K
authors.initials: VK
authors.lastname: Kumar
authors.forename: David M
authors.initials: DM
authors.lastname: Bamberger
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Clough
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D023801:Directly Observed Therapy / Q000379:methods / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents