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Effect of individual cognitive behaviour intervention on adherence to antiretroviral therapy: prospective randomized
Rainer Weber1, Lisanne Christen, Stephan Christen
1Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, Switzerland. infweb@usz.unizh.ch
Objective:
A high level of adherence to antiretroviral therapy is required for complete suppression of HIV replication, immunological and clinical effectiveness. We investigated whether cognitive behaviour therapy can improve medication adherence.
Design:
Prospective randomized 1-year trial.
Setting:
Collaboration of HIV university outpatient clinic and psychotherapists in private practice.
Participants:
60 HIV-infected persons on stable antiretroviral combination therapy and viral load below 50 copies/ml.
Intervention:
Cognitive behaviour intervention in individual patients, in addition to standard of care.
Main Outcome Measures:
Feasibility and acceptance of intervention; adherence to therapy assessed using medication event monitoring system (MEMS) and self-report questionnaire; virological failure; psychosocial measures.
Results:
The median number of sessions for cognitive behaviour intervention per patient during the 1-year trial was 11 (range 2-25). At months 10-12, mean adherence to therapy as assessed using MEMS was 92.8% in the intervention and 88.9% in the control group (P=0.2); the proportion of patients with adherence > or = 95% was 70 and 50.0% (P=0.014), respectively. While there was no significant deterioration of adherence during the study in the intervention arm, adherence decreased by 8.7% per year (P=0.006) in the control arm. No differences between the intervention group and standard of care group were found regarding virological outcome. Compared with the control group, participants in the intervention group perceived a significant improvement of their mental health during the study period.
Conclusions:
Cognitive behavioural support in addition to standard of care of HIV-infected persons is feasible in routine practice, and can improve medication adherence and mental health.