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Efficacy of an individualized adherence support program with contingent reinforcement among nonadherent HIV-positive
Marjan Javanbakht1, Paul Prosser, Tim Grimes
1AIDS Healthcare Foundation, 2615 South Grand Avenue, Room 500, Los Angeles, CA 90007, USA. javan@ucla.edu
Objective:
To evaluate the efficacy of a program designed to improve adherence to antiretroviral therapy among patients with poor adherence.
Methods:
A randomized intervention trial was conducted among 90 HIV-positive patients experiencing treatment failure as a result of noncompliance with their medication regimen. Eligible participants were randomly assigned to an adherence case management intervention with monetary reinforcement (CM) or to a standard of care group (SC). The CM participants met regularly with a treatment advocate for individualized adherence support. Efficacy was measured in terms of reductions in viral load and improvements in immune function at weeks 12, 24, and 48.
Results:
After 48 weeks, 55% (n=26) of those in the CM achieved at least a 1-log10 drop in viral load as compared to 28% (n=12) in the SC group (P=.0089). Furthermore, the mean CD4 count was 209 cells/mm3 for the CM group as compared to 150 cells/mm3 in the SC group (P=.0333). Based on logistic regression analysis, being in the CM was an independent predictor of reduction in viral load (odds ratio=2.49; P=.0514).
Conclusion:
The individualized adherence intervention is feasible and effective in reducing viral load and improving immune function.
