Patient Support and Education for Promoting Adherence to Highly Active Antiretroviral Therapy for HIV/AIDS

University of Toronto, Toronto, Ontario, Canada
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2006; 3(3):CD001442. DOI: 10.1002/14651858.CD001442.pub2
Source: PubMed


People living with HIV/AIDS are required to achieve high levels of adherence to benefit from many antiretroviral regimens. This review identified 19 studies involving a total of 2,159 participants that evaluated an intervention intended to improve adherence. Ten of these studies demonstrated a beneficial effect of the intervention. 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 to antiretroviral therapy. 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 did not find studies that evaluated the quality of the patient-provider relationship or the clinical setting. Most studies had several methodological shortcomings.

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    • "A study conducted in Gonder University hospital in Ethiopia also revealed LTFU of 46% in one year treatment (Wubshet et al., 2012). Factors such as age, having low baseline CD4-cell count, being ambulatory and financial constraints were found to be predictors for LTFU in many studies (Rueda et al., 2006; Wubshet et al., 2012). Other reasons for LTFU were, improvement in health, adverse effects and feeling sick or being hospitalized (Braitstein et al., 2006; Ammassari et al., 2002). "

    01/2015; 7(1):1-9. DOI:10.5897/JAHR2014.0315
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    • "management include common health promoting activities such as eating a healthy diet or engaging in physical activity; health maintenance activities including medication adherence and accessing appropriate medical services; improving psychological and emotional functioning through self-efficacy and empowerment exercises and reducing negative emotional states; and improving social relationships by developing collaborative relationships with health care providers, developing and using a positive social support network, and coping with HIV stigma (Swendeman, Ingram, & Rotheram-Borus, 2009). Most self-management interventions have focused on HIV medication adherence or safe sex (Lyles et al., 2007; Rueda et al., 2006; Sandelowski, Voils, Chang, & Lee, 2009), however there is great opportunity within the field to adopt a more holistic approach and target the upstream behaviors to promote the overall health of the person living with HIV (High et al., 2012). For people living with HIV, self-management is a lifelong endeavor, and one that may be substantially affected by the social contexts in which they live. "
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    ABSTRACT: HIV self-management is central to the health of people living with HIV and is comprised of the daily tasks individuals employ to manage their illness. Women living with HIV are confronted with social context vulnerabilities that impede their ability to conduct HIV self-management behaviors, including demanding social roles, poverty, homelessness, decreased social capital, and limited access to health care. We examined the relationship between these vulnerabilities and HIV self-management in a cross-sectional secondary analysis of 260 women living with HIV from two U.S. sites. All social context variables were assessed using validated self-report scales. HIV Self-Management was assessed using the HIV Self-Management Scale that measures daily health practices, HIV social support, and the chronic nature of HIV. Data were analyzed using appropriate descriptive statistics and multivariable regression. Mean age was 46 years and 65% of participants were African-American. Results indicated that social context variables, particularly social capital, significantly predicted all domains of HIV self-management including daily health practices (F=5.40, adjusted R2=0.27, p<0.01), HIV social support (F=4.50, adjusted R2=0.22, p<0.01), and accepting the chronic nature of HIV (F=5.57, adjusted R2=0.27, p<0.01). We found evidence to support the influence of the traditional social roles of mother and employee on the daily health practices and the chronic nature of HIV domains of HIV self-management. Our data support the idea that women's social context influences their HIV self-management behavior. While social context has been previously identified as important, our data provide new evidence on which aspects of social context might be important targets of self-management interventions for women living with HIV. Working to improve social capital and to incorporate social roles into the daily health practices of women living with HIV may improve the health of this population.
    Social Science [?] Medicine 06/2013; 87:147-54. DOI:10.1016/j.socscimed.2013.03.037 · 2.89 Impact Factor
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    • "Educational chronic disease self-management programmes have proliferated in recent years, but their efficacy over the long term has been questioned (Newman et al. 2004, Swerrisen et al. 2006, Khunti et al. 2012). Person-centred strategies, such as coaching (Vale et al. 2003, Young et al. 2007), and motivational interviewing (Rueda et al. 2009) have the potential to detect patients' concerns in managing their medicines and therefore have the propensity to identify helpful strategies for chronic disease self-management. We developed a patient-centred intervention to improve medicine adherence in people with diabetes, CKD and hypertension (Williams et al. 2012). "
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    ABSTRACT: To explore the motivation and confidence of people with coexisting diabetes, chronic kidney disease (CKD) and hypertension to take their medicines as prescribed. These comorbidities are major contributors to disease burden globally. Self-management of individuals with these coexisting diseases is much more complicated than that of those with single diseases and is critical for improved health outcomes. Motivational interviewing telephone calls were made with participants with coexisting diabetes, CKD and hypertension. Patients aged ≥18 years with diabetes, CKD and systolic hypertension were recruited from outpatient clinics of an Australian metropolitan hospital between 2008-2009. An average of four motivational interviewing telephone calls was made with participants (n = 39) in the intervention arm of a randomised controlled trial. Data were thematically analysed using the modified Health Belief Model as a framework. Participants' motivation and confidence in taking prescribed medicines was thwarted by complex medicine regimens and medical conditions. Participants wanted control over their health and developed various strategies to confront threats to health. The perceived barriers of taking recommended health action outweighed the benefits of taking medicines as prescribed and were primarily related to copious amounts of medicines. Taking multiple prescribed medicines in coexisting diabetes, CKD and hypertension is a perpetual vocation with major psychosocial effects. Participants were overwhelmed by the number of medicines that they were required to take. The quest for personal control of health, fear of the future and the role of stress and gender in chronic disease management have been highlighted. Participants require supportive emotional interventions to self-manage their multiple medicines on a daily basis. Reducing the complexity of medicine regimens in coexisting diseases is paramount. Individualised psychosocial approaches that address the emotional needs of patients with regular follow-up and feedback are necessary for optimal chronic disease self-management.
    Journal of Clinical Nursing 01/2013; 23(3-4):471-481. DOI:10.1111/jocn.12171 · 1.26 Impact Factor
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