title: Improving Adherence to Care Among "Hard to Reach" HIV-Infected Patients in Argentina.
abstract: Many HIV-infected patients fail to achieve undetectable viral load and are not retained in care. This pilot study examined patients lost to care in public and private clinics in Buenos Aires, Argentina. The impact of patient and provider interventions was compared separately and collectively. In Phase 1, participants prescribed antiretrovirals and non-adherent to treatment in the prior 3-6 months (n = 60) were randomized to patient intervention or standard of care (SOC) and assessed over 12 months. In Phase 2, providers were trained in interviewing techniques and 60 additional patients were randomized to patient intervention or SOC condition. Averaged across patient intervention status, Phase 2 provider intervention patients reported the most improved adherence and viral suppression at 6 and 12 months. Adherence in "patient intervention only" improved at midpoint and returned to baseline at 12 months. Results suggest provider training sustained patient adherence and viral suppression among "hard to reach" patients.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, 1400 NW 10th Ave., Miami, FL, 33136, USA. djones@med.miami.edu.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Jones
authors.affiliation: Clinical Research Department, Fundación Huésped, Buenos Aires, Argentina.
authors.forename: Omar
authors.initials: O
authors.lastname: Sued
authors.affiliation: Helíos Salud, Buenos Aires, Argentina.
authors.forename: Diego
authors.initials: D
authors.lastname: Cecchini
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, 1400 NW 10th Ave., Miami, FL, 33136, USA.
authors.forename: Lina
authors.initials: L
authors.lastname: Bofill
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, 1400 NW 10th Ave., Miami, FL, 33136, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Cook
authors.affiliation: Clinical Research Department, Fundación Huésped, Buenos Aires, Argentina.
authors.forename: Mar
authors.initials: M
authors.lastname: Lucas
authors.affiliation: Helíos Salud, Buenos Aires, Argentina.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Bordato
authors.affiliation: Helíos Salud, Buenos Aires, Argentina.
authors.forename: Isabel
authors.initials: I
authors.lastname: Cassetti
authors.affiliation: Clinical Research Department, Fundación Huésped, Buenos Aires, Argentina.
authors.forename: Pedro
authors.initials: P
authors.lastname: Cahn
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, 1400 NW 10th Ave., Miami, FL, 33136, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Weiss
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001118:Argentina; D003376:Counseling; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology / Q000821:virology; D057220:Health Literacy; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000208:ethnology / Q000523:psychology*; D008875:Middle Aged; D062405:Motivational Interviewing; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic / Q000379:methods*; D010865:Pilot Projects; D017149:Private Sector; D011369:Professional-Patient Relations; D017150:Public Sector; D016896:Treatment Outcome; D019562:Viral Load; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents
keywords: Adherence; Argentina; Engagement; HIV; Provider intervention