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Wiginton JM, Amico KR, Hightow-Weidman L, Sullivan P, Horvath KJ. Emotion regulation as a potential moderator of the association between HIV stigma and nonadherence to antiretroviral therapy among youth living with HIV. J Adolesc 2024. [PMID: 38488698 DOI: 10.1002/jad.12315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Human immunodeficiency virus (HIV)-related stigma affects adherence to antiretroviral therapy (ART) for youth living with HIV. Emotion regulation strategies such as cognitive reappraisal (reinterpreting adversity to mitigate emotional impact) and expressive suppression (inhibiting emotion-expressive behavior activated by adversity) may moderate the HIV stigma-ART adherence relationship in this group. METHODS Using baseline data from 208 youth living with HIV aged 15-24 years enrolled in an mHealth ART-adherence intervention, we performed modified Poisson regressions with robust variance between HIV stigma (internalized, anticipated, enacted) and ART nonadherence. We tested for multiplicative interaction via product terms between HIV stigma and emotion regulation scores, and additive interaction via relative excess risk due to interaction and attributable proportion using dichotomous HIV stigma and emotion regulation variables. RESULTS Mean age was 21 years; ≥50% of participants were cisgender male, non-Hispanic Black, and gay-identifying; 18% reported ART nonadherence. Confounder-adjusted regressions showed positive associations between each HIV stigma variable and ART nonadherence. Internalized HIV stigma and cognitive reappraisal negatively, multiplicatively interacted (as internalized HIV stigma increased, ART nonadherence increased for those with low cognitive reappraisal). High internalized HIV stigma positively, additively interacted with low cognitive reappraisal and low expressive suppression (when high internalized HIV stigma and low levels of either emotion regulation strategy were present, ART nonadherence increased dramatically). CONCLUSION Cognitive reappraisal and expressive suppression may protect against internalized HIV stigma's harmful association with ART nonadherence. These modifiable emotion regulation strategies may be targeted to potentially buffer the effects of internalized HIV stigma and support ART adherence for youth living with HIV.
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Affiliation(s)
- John Mark Wiginton
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California-San Diego, La Jolla, California, USA
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa Hightow-Weidman
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, Florida, USA
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, California, USA
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Boucher J, Lucca J, Hooper C, Pedulla L, Berry DL. A Structured Nursing Intervention to Address Oral Chemotherapy Adherence in Patients With Non-Small Cell Lung Cancer. Oncol Nurs Forum 2016; 42:383-9. [PMID: 26148317 DOI: 10.1188/15.onf.383-389] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate a nurse-led intervention to enhance medication knowledge and adherence using the Multinational Association for Supportive Care in Cancer Oral Agent Teaching Tool (MOATT). DESIGN Longitudinal, descriptive feasibility study. SETTING An ambulatory thoracic oncology disease center located at the Dana-Farber Cancer Institute in Boston, MA. SAMPLE 30 adult patients with lung cancer who received the oral agent erlotinib. METHODS Structured, nurse-led education sessions using the MOATT were provided, with a 72-hour follow-up telephone contact. Participants completed a Knowledge Rating Scale (KRS) and adapted Morisky Medication Adherence Scale-8 (MMAS-8) at the end of the first cycle of oral chemotherapy. MAIN RESEARCH VARIABLES Knowledge and adherence; feasibility. FINDINGS Twenty-seven participants completed the study outcome measures reporting high knowledge levels and MMAS-8 scores. Structured, nurse-led education and follow-up monitoring sessions ranged from 14-30 minutes. Several participants also initiated contact for assistance with prescription procurement and symptom management. Participants reported a median of two side effects. CONCLUSIONS The structured, nurse-led teaching, using the MOATT tool, and follow-up nurse contacts were feasible as integrated into the thoracic oncology setting. Adherence and knowledge outcomes were encouraging. Additional studies should include objective adherence measures and strategies for delivering supportive care to patients at home. IMPLICATIONS FOR NURSING Structured teaching with patients is important to enhance proper oral anticancer medication knowledge and adherence, including follow-up monitoring of administration and side effects at 72 hours.
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Affiliation(s)
- Jean Boucher
- Phyllis F. Cantor Center at Dana-Farber Cancer Institute in Boston, MA, and the University of Massachusetts Worcester Graduate School of Nursing
| | - Joan Lucca
- Lowe Center for Thoracic Oncology at Dana-Farber Cancer Institute
| | - Catherine Hooper
- Lowe Center for Thoracic Oncology at Dana-Farber Cancer Institute
| | | | - Donna L Berry
- Phyllis F. Cantor Center at Dana-Farber Cancer Institute
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Conn VS, Ruppar TM, Enriquez M, Cooper P. Medication adherence interventions that target subjects with adherence problems: Systematic review and meta-analysis. Res Social Adm Pharm 2016; 12:218-46. [PMID: 26164400 PMCID: PMC4679728 DOI: 10.1016/j.sapharm.2015.06.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/06/2015] [Accepted: 06/06/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Inadequate medication adherence is a pervasive, under-recognized cause of poor health outcomes. Many intervention trials designed to improve medication adherence have targeted adults with adherence problems. No previous reviews have synthesized the effectiveness of medication adherence interventions focused on subjects with medication adherence difficulties. OBJECTIVE This systematic review and meta-analysis synthesized findings from medication adherence intervention studies conducted among adults with medication adherence difficulties. METHODS Primary research studies were eligible for inclusion if they tested an intervention designed to increase medication adherence among adults with documented adherence difficulties and reported medication adherence behavior outcomes. Comprehensive search strategies of 13 computerized databases, author and ancestry searches, and hand searches of 57 journals were used to locate eligible primary research. Participant demographics, intervention characteristics, and methodological features were reliably coded from reports along with medication adherence outcomes. Effect sizes for outcomes were calculated as standardized mean differences, and random effects models were used to estimate overall mean effects. Exploratory dichotomous and continuous variable moderator analyses were employed to examine potential associations between medication adherence effect size and sample, intervention, and methodological characteristics. RESULTS Data were extracted from 53 reports of studies involving 8243 individual primary study participants. The overall standardized mean difference effect size for treatment vs. control subjects was 0.301. For treatment pre- vs. post-intervention comparisons, the overall effect size was 0.533. Significantly larger effect sizes were associated with interventions incorporating prompts to take medications than interventions lacking medication prompts (0.497 vs. 0.234). Larger effect sizes were also found for interventions that linked medication taking with existing habits compared to interventions that did not (0.574 vs. 0.222). Effect sizes were largest among studies that measured adherence by pill counts or electronic event monitoring systems. Analysis of study design features identified several potential risks of bias. Statistically significant publication bias was detected, but adherence effect sizes were not significantly associated with other risks of bias. CONCLUSIONS These findings document that interventions targeting individuals with medication adherence problems can have modest but significant effects on medication-taking behavior. The findings support the use of behavioral strategies such as prompts and linking medications to habits to increase medication adherence in adults with adherence challenges. Face-to-face interventions appear to be critical for patients who have experienced past problems with medication adherence.
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Affiliation(s)
- Vicki S. Conn
- Sinclair School of Nursing; University of Missouri; Columbia, MO 65211; USA
| | - Todd M. Ruppar
- Sinclair School of Nursing; University of Missouri; Columbia, MO 65211; USA
| | - Maithe Enriquez
- Sinclair School of Nursing; University of Missouri; Columbia, MO 65211; USA
| | - Pam Cooper
- Sinclair School of Nursing; University of Missouri; Columbia, MO 65211; USA
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Maclachlan EW, Shepard-Perry MG, Ingo P, Uusiku J, Mushimba R, Simwanza R, Likoro J, Brandt LJ, Thomas KK, Kasonka C, Hamunime N, O'Malley G. Evaluating the effectiveness of patient education and empowerment to improve patient-provider interactions in antiretroviral therapy clinics in Namibia. AIDS Care 2015; 28:620-7. [PMID: 26695005 PMCID: PMC4841015 DOI: 10.1080/09540121.2015.1124975] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 11/23/2015] [Indexed: 11/04/2022]
Abstract
In order to increase patient active engagement during patient-provider interactions, we developed and implemented patient training sessions in four antiretroviral therapy (ART) clinics in Namibia using a "Patient Empowerment" training curriculum. We examined the impact of these trainings on patient-provider interactions after the intervention. We tested the effectiveness of the intervention using a randomized parallel group design, with half of the 589 enrolled patients randomly assigned to receive the training immediately and the remaining randomized to receive the training 6 months later. The effects of the training on patient engagement during medical consultations were measured at each clinic visit for at least 8 months of follow-up. Each consultation was audiotaped and then coded using the Roter Interaction Analysis System (RIAS). RIAS outcomes were compared between study groups at 6 months. Using intention-to-treat analysis, consultations in the intervention group had significantly higher RIAS scores in doctor facilitation and patient activation (adjusted difference in score 1.19, p = .004), doctor information gathering (adjusted difference in score 2.96, p = .000), patient question asking (adjusted difference in score .48, p = .012), and patient positive affect (adjusted difference in score 2.08, p = .002). Other measures were higher in the intervention group but did not reach statistical significance. We have evidence that increased engagement of patients in clinical consultation can be achieved via a targeted training program, although outcome data were not available on all patients. The patient training program was successfully integrated into ART clinics so that the trainings complemented other services being provided.
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Affiliation(s)
- Ellen W Maclachlan
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
| | - Mark G Shepard-Perry
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
| | - Paulina Ingo
- b International Training and Education Center for Health (I-TECH) , Ondangwa , Namibia
| | - James Uusiku
- b International Training and Education Center for Health (I-TECH) , Ondangwa , Namibia
| | - Ruusa Mushimba
- c International Organization for Migration (IOM) , Windhoek , Namibia
| | - Ricky Simwanza
- d Ministry of Health and Social Services (MoHSS) , Katima Mulilo , Namibia
| | - Joseph Likoro
- e The Global Fund to Fight AIDS, Tuberculosis and Malaria , Windhoek , Namibia
| | - Laura J Brandt
- f International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health , Windhoek , Namibia
| | - Katherine K Thomas
- g International Clinical Research Center (ICRC), University of Washington Department of Global Health , Seattle , WA , USA
| | - Claude Kasonka
- h Monitoring and Evaluation Unit , Millennium Challenge Account , Lusaka , Zambia
| | - Ndapewa Hamunime
- i Namibia Ministry of Health and Social Services , Directorate of Special Programs (MoHSS/DSP, Windhoek, Namibia)
| | - Gabrielle O'Malley
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
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3Ps--Pharmacist, Physician and Patient: Proposal for Joint Cooperation to Increase Adherence to Medication. W INDIAN MED J 2015; 63:744-51. [PMID: 25867560 DOI: 10.7727/wimj.2013.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 11/28/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Older people receive medications for chronic diseases and therefore adherence is an important health and economic concern. The objective of the study is to determine relationships between pharmacist, patient and patient's family physician with special emphasis on the comparison of adherent and non-adherent patients. METHODS The study was designed as a cross-sectional survey by use of a self-administered 33-item questionnaire. The study included 635 individuals collecting or buying drugs for the treatment of chronic diseases and 84 pharmacists dispensing drugs for chronic diseases to patients. RESULTS The study included 265 (41.7%) adherent and 370 (58.3%) non-adherent patients. Comparison of particular answers between patients and pharmacists revealed a discrepancy, with a significant difference in five of eight answers. The highest difference was recorded in answers to the question whether a pharmacist offered thorough advice to the patient on how to take the drug; an affirmative answer to this question was given by 90.5% of pharmacists and only 57.2% of patients. The analysis of respondents' claims about their relation with one doctor shows that in the first place, with the highest number of positive responses, is the claim of the respondents that their doctor always explains the results of laboratory tests and other specialized findings (n = 489, 77.0%). CONCLUSION Enhancing communication between the physician, the pharmacist and the patient is a key in boosting the patient's ability to follow a medication regimen. Pharmacist-physician-patient relationship can improve adherence to medication. It is very important to empower pharmacists to offer and allow time for patient counselling.
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Abstract
INTRODUCTION Access to antiretroviral treatment (ART) has substantially improved over the past decade. In this new era of HIV as a chronic disease, the continued success of ART will depend critically on sustained high ART adherence. The objective of this review was to systematically review interventions that can improve adherence to ART, including individual-level interventions and changes to the structure of ART delivery, to inform the evidence base for the 2013 WHO consolidated antiretroviral guidelines. DESIGN A rapid systematic review. METHODS We conducted a rapid systematic review of the global evidence on interventions to improve adherence to ART, utilizing pre-existing systematic reviews to identify relevant research evidence complemented by screening of databases for articles published over the past 2 years on evidence from randomized controlled trials (RCTs). We searched five databases for both systematic reviews and primary RCT studies (Cochrane Library, EMBASE, MEDLINE, Web of Science, and WHO Global Health Library); we additionally searched ClinicalTrials.gov for RCT studies. We examined intervention effectiveness by different study characteristics, in particular, the specific populations who received the intervention. RESULTS A total of 124 studies met our selection criteria. Eighty-six studies were RCTs. More than 20 studies have tested the effectiveness of each of the following interventions, either singly or in combination with other interventions: cognitive-behavioural interventions, education, treatment supporters, directly observed therapy, and active adherence reminder devices (such as mobile phone text messages). Although there is strong evidence that all five of these interventions can significantly increase ART adherence in some settings, each intervention has also been found not to produce significant effects in several studies. Almost half (55) of the 124 studies investigated the effectiveness of combination interventions. Combination interventions tended to have effects that were similar to those of single interventions. The evidence base on interventions in key populations was weak, with the exception of interventions for people who inject drugs. CONCLUSION Tested and effective adherence-enhancing interventions should be increasingly moved into implementation in routine programme and care settings, accompanied by rigorous evaluation of implementation impact and performance. Major evidence gaps on adherence-enhancing interventions remain, in particular, on the cost-effectiveness of interventions in different settings, long-term effectiveness, and effectiveness of interventions in specific populations, such as pregnant and breastfeeding women.
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DeFulio A, Silverman K. The use of incentives to reinforce medication adherence. Prev Med 2012; 55 Suppl:S86-94. [PMID: 22580095 PMCID: PMC3424340 DOI: 10.1016/j.ypmed.2012.04.017] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 04/24/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Poor medication adherence is a longstanding problem, and is especially pertinent for individuals with chronic conditions or diseases. Adherence to medications can improve patient outcomes and greatly reduce the cost of care. The purpose of the present review is to describe the literature on the use of incentives as applied to the problem of medication adherence. METHODS We conducted a systematic review of peer-reviewed empirical evaluations of incentives provided to patients contingent upon medication adherence. RESULTS This review suggests that incentive-based medication adherence interventions can be very effective, but there are few controlled studies. The studies on incentive-based medication adherence interventions most commonly feature patients taking medication for drug or alcohol dependence, HIV, or latent tuberculosis. Across studies that reported percent adherence comparisons, incentives increased adherence by a mean of 20 percentage points, but effects varied widely. Cross-study comparisons indicate a positive relationship between the value of the incentive and the impact of the intervention. Post-intervention evaluations were rare, but tended to find that adherence effects diminish after the interventions are discontinued. CONCLUSIONS Incentive-based medication adherence interventions are promising but understudied. A significant challenge for research in this area is the development of sustainable and cost-effective long-term interventions.
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Affiliation(s)
- Anthony DeFulio
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Baltimore MD 21224, USA.
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Attrition and related trends in scientific rigor: a score card for ART adherence intervention research and recommendations for future directions. Curr HIV/AIDS Rep 2008; 5:172-85. [PMID: 18838057 DOI: 10.1007/s11904-008-0026-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Scientific rigor in intervention trials is frequently used in systems that identify effective interventions for dissemination. In these systems, and in work that synthesizes bodies of research, percent attrition is often considered a fatal threat to validity. However, differential attrition, versus percent total, is of primary concern. Key methodologic, design, and analytic issues pertaining to scientific rigor in longitudinal designs were identified, and the current literature on antiretroviral therapy adherence interventions (k = 51) was evaluated in relation to these. Although results suggest that this body of literature has progressed in rigor, improvements are needed in transparency of reporting participant flow, retention strategies, handling of missing data, and characterization of retained and lost cohorts. Attrition averaged 30% total, and differential by study arm was estimated at 9%. Differential attrition continues to be underreported and is not well represented by the more frequently used, though arguably less appropriate, metric of overall percent attrition.
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Ventura Cerdá JM, Casado Gómez MA, Escobar Rodríguez I, Ibarra Barrueta O, Ortega Valín L, Morales González JM, Cotarelo Suárez M. [Preferences, satisfaction and compliance with antiretroviral treatment: ARPAS study (II)]. FARMACIA HOSPITALARIA 2008; 31:340-52. [PMID: 18348665 DOI: 10.1016/s1130-6343(07)75406-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To describe the ARPAS study and analyse the sociodemographic and clinical characteristics and patient preferences with regards the antiretroviral treatment (ART), as well as the relationship between compliance and satisfaction with the ART and quality of life. METHOD The ARPAS study has looked at adult patients diagnosed with HIV and on ART, using a protocol including sociodemographic, clinical, therapeutic and quality of life variables. Compliance was estimated using the SMAQ questionnaire; satisfaction was measured using the ESTAR questionnaire, as was quality of life with the MOS-HIV Health Survey, and treatment preferences were determined using a questionnaire prepared based on the consensus of an expert team in the field of therapeutic monitoring of these patients. A stratified univariate analysis according to compliance and a logistic regression analysis were carried out to study the association of the independent variables with compliance. RESULTS A total of 234 patients were evaluated (73.7% male; 43.2+/-7.8 years of age). The average time since diagnosis and from the initiation of ART was 10.1+/-5.7 and 7.4+/-4.4 years respectively. The therapeutic regime of twice-daily doses (bid) was applied to 71% of the patients, and once daily (qd) in 21%. A total of 43% of the patients fulfilled compliance criteria according to the SMAQ. The percentage of the patients with qd complying with the ART was greater than the remaining dosing schedules (55.3 vs. 45.1%), although not significantly (p=0.251). No differences were observed in the sociodemographic and clinical variables in terms of compliance. An elective preference was observed for the simplest of the therapeutic regimes which contrasts with the evaluation of the ART characteristics, where power is given preference over durability, tolerance and lastly, the convenience of taking the ART. The univariate analysis showed the highest score on the satisfaction scales (50.4+/-7.8 vs. 46.5+/-9.7, p=0.001) and quality of life (81.6+/-10.7 vs. 75.7+/-11.8, p<0.001) in compliant patients with respect to non-compliers. The multivariate models confirm the existence of a significant association between compliance and satisfaction, and between compliance and quality of life. CONCLUSIONS Patients consider treatment with a powerful, long-lasting and well-tolerated ART a priority and among their preferences for different treatment regimes, once-daily dosing regimes are highlighted. The ARPAS study showed a direct relationship between compliance and satisfaction with ART, and between compliance and quality of life, in a manner that the strategies improving compliance must necessarily include aspects that allow them to improve patient satisfaction with treatment and quality of life.
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Affiliation(s)
- J M Ventura Cerdá
- Grupo de Trabajo VIH/SIDA, Sociedad Española de Farmacia Hospitalaria.
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The impact of medication regimen factors on adherence to chronic treatment: a review of literature. J Behav Med 2008; 31:213-24. [PMID: 18202907 DOI: 10.1007/s10865-007-9147-y] [Citation(s) in RCA: 360] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Accepted: 12/18/2007] [Indexed: 12/13/2022]
Abstract
This article reviews recent literature in chronic illness or long-term health management including asthma, contraception, diabetes, HIV disease, and hypertension/cardiovascular disease, mental disorders, pain, and other diseases to determine the relationship between regimen factors and adherence to medications. The authors conducted an electronic literature search to detect articles published between 1998 and 2007. Articles were included if they pertained to a chronic illness or to contraception, included a clear definition of how adherence was measured, and included regimen factors as primary or secondary explanatory variables. Methodology of the studies varied greatly, as did methods of measuring adherence and regimen factors. Surprisingly few of these articles concerned (1) chronic treatment, (2) regimen factors such as dosing, pill burden, and regimen complexity, and (3) adherence measured in a clear manner. Most studies failed to use state-of-the-art methods of measuring adherence. Despite these flaws, a suggestive pattern of the importance of regimen factors, specifically dose frequency and regimen complexity, emerged from this review.
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Molassiotis A, Morris K, Trueman I. The importance of the patient–clinician relationship in adherence to antiretroviral medication. Int J Nurs Pract 2007; 13:370-6. [DOI: 10.1111/j.1440-172x.2007.00652.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Balfour L, Kowal J, Silverman A, Tasca GA, Angel JB, Macpherson PA, Garber G, Cooper CL, Cameron DW. A randomized controlled psycho-education intervention trial: Improving psychological readiness for successful HIV medication adherence and reducing depression before initiating HAART. AIDS Care 2007; 18:830-8. [PMID: 16971295 DOI: 10.1080/09540120500466820] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to evaluate a novel psycho-educational intervention intended to increase patients' medication preparedness and treatment adherence skills before initiating highly active antiretroviral therapy (HAART). Sixty-three HIV-positive patients not currently on antiretroviral therapy participated in a randomized controlled trial of a standardized, four-session psycho-educational intervention (Supportive Therapy for Adherence to Antiretroviral Treatment; STAART). Session topics included learning techniques to increase medication adherence and learning effective strategies to cope with stress and depression. Patients completed psychological questionnaires assessing psychological readiness to initiate HAART and depressed mood. They completed both measures at study baseline and at four-weeks post-baseline. After controlling for baseline medication readiness scores, intervention patients (n = 30) reported significantly higher mean medication readiness following the STAART intervention (four-weeks post-baseline) (27.3+/-6.9) compared to controls (n = 33; 24.6+/-9.9; p < 0.05). Among depressed patients (n = 27), those receiving the intervention (n = 15) reported significantly lower mean depression scores at four-weeks post-baseline (22.5+/-12.9) compared to controls (n = 12; 27+/-9.9; p < 0.05). The STAART intervention enhanced HIV treatment readiness by better preparing patients prior to initiating HAART. It was also beneficial for reducing depressive symptoms in depressed, HIV-positive patients.
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Affiliation(s)
- L Balfour
- Division of Infectious Diseases, Ottawa Hospital-General Campus, Ottawa, Ontario, USA.
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Rueda S, Park‐Wyllie LY, Bayoumi A, Tynan A, Antoniou T, Rourke S, Glazier R. Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS. Cochrane Database Syst Rev 2006; 2006:CD001442. [PMID: 16855968 PMCID: PMC7045748 DOI: 10.1002/14651858.cd001442.pub2] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adherence to prescribed regimens is required to derive maximal benefit from many highly active antiretroviral therapy (HAART) regimens in people living with HIV/AIDS. OBJECTIVES To conduct a systematic review of the research literature on the effectiveness of patient support and education to improve adherence to HAART. SEARCH STRATEGY A systematic search of electronic databases was performed from January 1996 to May 2005. SELECTION CRITERIA Randomized controlled trials examining the effectiveness of patient support and education to improve adherence to HAART were considered for inclusion. Only those studies that measured adherence at a minimum of six weeks were included. DATA COLLECTION AND ANALYSIS Study selection, quality assessments and data abstraction were performed independently by two reviewers. MAIN RESULTS Nineteen studies involving a total of 2,159 participants met criteria for inclusion. It was not possible to conduct a meta-analysis due to study heterogeneity with respect to populations, interventions, comparison groups, outcomes, and length of follow-up. Sample sizes ranged from 22 to 367. The populations studied ranged from general HIV-positive populations to studies focusing exclusively on children, women, Latinos, or adults with a history of alcohol dependence, to studies focusing almost exclusively on men. Study interventions included cognitive behavioral therapy, motivational interviewing, medication management strategies, and interventions indirectly targeting adherence, such as programs directed to reduce risky sexual behaviours. Ten studies demonstrated a beneficial effect of the intervention on adherence. We found that interventions targeting practical medication management skills, those administered to individuals vs groups, and those interventions delivered over 12 weeks or more were associated with improved adherence outcomes. We also found that interventions targeting marginalized populations such as women, Latinos, or patients with a past history of alcoholism were not successful at improving adherence. We were unable to determine whether effective adherence interventions were associated with improved virological or immunological outcomes. Most studies had several methodological shortcomings leaving them vulnerable to potential biases. AUTHORS' CONCLUSIONS We found evidence to support the effectiveness of patient support and education interventions intended to improve adherence to antiretroviral therapy. Interventions targeting practical medication management skills, those interventions administered to individuals vs groups, and those interventions delivered over 12 weeks or more were associated with improved adherence outcomes. There is a need for standardization and increased methodological rigour in the conduct of adherence trials.
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Affiliation(s)
- Sergio Rueda
- St. Michael's HospitalMental Health Service, Neurobehavioural Unit30 Bond StreetToronto, OntarioCanadaM5B 1W8
| | - Laura Y. Park‐Wyllie
- St. Michael's HospitalCentre for Research on Inner City Health30 Bond StreetToronto, ONCanadaM5B 1W8
| | | | - Anne‐Marie Tynan
- Inner City Health Research UnitSt Michael's Hospital30 Bond StreetToronto, OntarioCanadaM5B 1W2
| | - Tony Antoniou
- St. Michael's HospitalDepartment of Family and Community Medicine410 Sherbourne StreetToronto, ONCanadaM4X 1K2
| | | | - Richard Glazier
- St. Michael's HospitalCentre for Research on Inner City Health30 Bond St.TorontoOntarioCanadaM5B 1W8
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Fisher JD, Fisher WA, Amico KR, Harman JJ. An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol 2006; 25:462-73. [PMID: 16846321 DOI: 10.1037/0278-6133.25.4.462] [Citation(s) in RCA: 451] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
HIV-positive persons who do not maintain consistently high levels of adherence to often complex and toxic highly active antiretroviral therapy (HAART) regimens may experience therapeutic failure and deterioration of health status and may develop multidrug-resistant HIV that can be transmitted to uninfected others. The current analysis conceptualizes social and psychological determinants of adherence to HAART among HIV-positive individuals. The authors propose an information-motivation-behavioral skills (IMB) model of HAART adherence that assumes that adherence-related information, motivation, and behavioral skills are fundamental determinants of adherence to HAART. According to the model, adherence-related information and motivation work through adherence-related behavioral skills to affect adherence to HAART. Empirical support for the IMB model of adherence is presented, and its application in adherence-promotion intervention efforts is discussed.
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Affiliation(s)
- Jeffrey D Fisher
- Department of Psychology and Center for Health/HIV Intervention and Prevention, University of Connecticut, Storrs, CT 06269-1020, USA.
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Amico KR, Harman JJ, Johnson BT. Efficacy of antiretroviral therapy adherence interventions: a research synthesis of trials, 1996 to 2004. J Acquir Immune Defic Syndr 2006; 41:285-97. [PMID: 16540929 DOI: 10.1097/01.qai.0000197870.99196.ea] [Citation(s) in RCA: 189] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To conduct a quantitative review of published trials of antiretroviral therapy (ART) adherence interventions. DESIGN A research synthesis of published ART adherence intervention outcome studies. SAMPLE ART adherence intervention outcome studies meeting inclusion criteria published between 1996 and December 2004 (k=24). MAIN OUTCOME MEASURE Effect sizes (ESs [d]) were calculated for each study outcome, producing 25 immediate postintervention outcomes and an additional 13 follow-up ESs. Reported pre- to post-ART adherence between groups (k = 15) or within groups (k = 10) served as the main outcome converted to standardized ES. RESULTS ART adherence interventions had a small effect (d = 0.35, odds ratio [OR] = 1.88) that varied considerably across studies. Interventions that specifically enrolled participants with known or anticipated problems with ART adherence demonstrated medium effects on adherence (d = 0.62, OR = 3.07). Interventions that did not target their participants on similar criteria had quite small effects(d = 0.19, OR = 1.41). Adherence improvements showed no tendency to decay across time. CONCLUSIONS Outcomes of studies targeting those with poor ART adherence had stronger effects than those intervening with groups of individuals who were mixed in terms of pretest levels of adherence. Adherence intervention outcome studies must carefully delineate their target populations, because defining individuals as "on ART" does not provide the level of specificity needed to design and implement effective interventions.
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Affiliation(s)
- K Rivet Amico
- Center for Health/HIV Intervention and Prevention, University of Connecticut, 2006 Hillside Road, Storrs, CT 06269-1248, USA.
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Affiliation(s)
- Lars Osterberg
- General Medicine Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, California 94304, USA.
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Castillo E, Palepu A, Beardsell A, Akagi L, Yip B, Montaner JSG, Hogg RS. Outpatient pharmacy care and HIV viral load response among patients on HAART. AIDS Care 2004; 16:446-57. [PMID: 15203413 DOI: 10.1080/09540120410001683385] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Adherence to highly active antiretroviral therapy (HAART) is necessary to achieve long-term effectiveness. The impact of HIV/AIDS-specific pharmacy services on patient adherence and HIV viral suppression is currently not well described. This study aimed to compare the impact of differing levels of HIV-pharmacy care on adherence and time to HIV viral suppression among participants on HAART enrolled in a population-based HIV/AIDS drug treatment programme in British Columbia. We performed a retrospective observational study of 788 treatment-naïve patients who started HAART between August 1997 and July 2000 and were followed until 31 March 2002. The degree of outpatient pharmacy care was defined according to pharmacy dispensing site for the participants' first prescription of HAART: highest at the AIDS-tertiary care hospital outpatient pharmacies, intermediate at HIV/AIDS drug treatment programme funded off-site pharmacies and lowest at family physician's offices. Cox-proportional hazard models examined the independent effect of pharmacy dispensing site on time to two consecutive HIV viral suppressions controlling for other prognostic factors including physicians' experience, age, gender, injection drug use, use of therapy containing NNRTI versus PI, adherence >90%, AIDS diagnosis at baseline, baseline CD4 cell count and HIV viral load. The median time on antiretrovirals was 28 months (IQR=14-38). There were 489 (62.1%) participants who obtained their medications from the AIDS-tertiary care outpatient pharmacies; 98 (12.4%) from off-site pharmacies and 201 (25.5%) from their physicians' offices. The proportion of patients exhibiting >90% adherence to treatment was observed to be higher among patients receiving their HAART at the AIDS-tertiary care pharmacies compared to off-site pharmacies and to physicians' offices (70.4, 59.2 and 55.7%, respectively; p=0.0001). After adjusting for other prognostic factors, subjects who were first dispensed medications from the AIDS-tertiary care pharmacy were 1.42 times (CI: 1.10-1.84) more likely to achieve HIV viral suppression than those getting their medications from off-site pharmacies and physicians' offices. Providing regular outpatient pharmacy care is independently associated with improved HIV viral load response through enhanced adherence to HAART. Standardization of pharmacy practices for dispensing HAART may improve outcomes for patients who receive their HIV medications from other non-tertiary care pharmacy sites.
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Affiliation(s)
- E Castillo
- Department of Health Care and Epideiology, University of British Columbia, Vancouver, Canada
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Green G, Smith R. The psychosocial and health care needs of HIV-positive people in the United Kingdom: a review. HIV Med 2004; 5 Suppl 1:5-46. [PMID: 15113395 DOI: 10.1111/j.1468-1293.2004.00210.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- G Green
- Department of Health and Human Sciences, University of Essex, Colchester, UK.
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