Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS (Review)

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

ABSTRACT 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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    • "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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    • "Since 2003, the results of pilot studies have demonstrated the feasibility of interventions to influence adherence [9-12], and some interventions evaluated in experimental studies have shown a potential to optimize adherence [13-22]. A systematic review of treatment adherence interventions intended for persons living with HIV (PLHIV) [23] suggested that individual interventions targeting medication management skills were associated with improved adherence outcomes (n = 10 studies). In their systematic review of interventions intended to optimize medication adherence among other groups, Haynes et al. [24] indicated that only 36 of the 83 interventions examined were associated with improved adherence. "
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    ABSTRACT: Background Living with HIV makes considerable demands on a person in terms of self-management, especially as regards adherence to treatment and coping with adverse side-effects. The online HIV Treatment, Virtual Nursing Assistance and Education (Virus de I’immunodéficience Humaine–Traitement Assistance Virtuelle Infirmière et Enseignement; VIH-TAVIE™) intervention was developed to provide persons living with HIV (PLHIV) with personalized follow-up and real-time support in managing their medication intake on a daily basis. An online randomized controlled trial (RCT) will be conducted to evaluate the efficacy of this intervention primarily in optimizing adherence to combination anti-retroviral therapy (ART) among PLHIV. Methods/design A convenience sample of 232 PLHIV will be split evenly and randomly between an experimental group that will use the web application, and a control group that will be handed a list of websites of interest. Participants must be aged 18 years or older, have been on ART for at least 6 months, and have internet access. The intervention is composed of four interactive computer sessions of 20 to 30 minutes hosted by a virtual nurse who engages the PLHIV in a skills-learning process aimed at improving self-management of medication intake. Adherence constitutes the principal outcome, and is defined as the intake of at least 95% of the prescribed tablets. The following intermediary measures will be assessed: self-efficacy and attitude towards antiretroviral medication, symptom-related discomfort, and emotional support. There will be three measurement times: baseline (T0), after 3 months (T3) and 6 months (T6) of baseline measurement. The principal analyses will focus on comparing the two groups in terms of treatment adherence at the end of follow-up at T6. An intention-to-treat (ITT) analysis will be carried out to evaluate the true value of the intervention in a real context. Discussion Carrying out this online RCT poses various challenges in terms of recruitment, ethics, and data collection, including participant follow-up over an extended period. Collaboration between researchers from clinical disciplines (nursing, medicine), and experts in behavioral sciences information technology and media will be crucial to the development of innovative solutions to supplying and delivering health services. Trial registration CE 11.184 / NCT 01510340
    Trials 10/2012; 13(1):187. DOI:10.1186/1745-6215-13-187 · 1.73 Impact Factor
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