Lessons learned from an HIV adherence pilot study in the Deep South

Area of Science:

• Public Health
• Behavioral Science
• Infectious Disease Management

Background:

• Adherence to treatment for chronic illnesses like HIV is crucial but challenging, especially in under-resourced settings.
• Practical interventions are needed to improve patient adherence in real-world clinical environments.
• The Information-Motivation-Behavioral Skills Model provides a framework for understanding and intervening in health behaviors.

Purpose of the Study:

• To test the feasibility of an adherence intervention for HIV-infected individuals in a public clinic in the Deep South.
• To evaluate study components and identify lessons learned for future adherence interventions.
• To assess the effectiveness of different adherence measures in a resource-limited setting.

Main Methods:

• A feasibility study involving 73 HIV-infected individuals was conducted.
• The intervention was based on the Information-Motivation-Behavioral Skills Model.
• Adherence was measured using refill rates and electronic monitoring (MEMS), with qualitative feedback collected.

Main Results:

• High baseline adherence was observed, but clinic attrition was unexpectedly high.
• Refill rate emerged as the adherence measure most strongly correlated with HIV viral load and CD4 count.
• Electronic adherence monitoring (MEMS) showed low usage and acceptance, while audio-supported computer-assisted survey instruments (ACASI) were well-received.

Conclusions:

• The study demonstrated feasible intervention components for HIV adherence in this population and setting.
• Clinic retention is critical for adherence; telephone interventions require enhanced technology and flexibility.
• Refill rate is a reliable adherence assessment, and consistent, caring support is valued by patients.