Cognitive-behavioral intervention to enhance adherence to antiretroviral therapy: a randomized controlled trial (CCTG 578).
ABSTRACT We conducted a randomized, multi-site, controlled trial of a cognitive-behavioral adherence intervention for patients initiating or changing an antiretroviral (ART) regimen.
A 3 x 2 factorial design was used with the primary randomization assigning patients (1: 1: 1) to one of two adherence interventions or usual care.
The five-session adherence interventions consisted of cognitive-behavioral and motivational components, with or without a 2-week pre-treatment placebo practice trial. Intent-to-treat analysis used probability weights and regression tree analysis to account for missing data.
A total of 230 patients were randomized; 199 started ART, of whom 74% completed the 48-week study. Electronic monitored adherence outcomes between the two intervention groups did not differ significantly and were thus pooled in analyses. At week 4, 82% of intervention patients had taken at least 90% of their prescribed ART doses, compared with 65% of controls (P < 0.01); this group difference dropped to 12% at week 12 (72 versus 60%; P = 0.15) and 11% at week 24 (66 versus 55%; P = 0.28). Mean adherence in the intervention group was significantly higher than the control group at week 24 (89 versus 81%; P < 0.05) only. There were no group differences with respect to HIV-1 RNA throughout the study.
The effects of the cognitive-behavioral intervention on adherence were modest and transient, and no effects were observed on viral load or CD4 cell count. More robust effects may require a more intense intervention that combines ongoing adherence monitoring and individualized intervention "dosage" that matches the need and performance of each patient.
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ABSTRACT: Purpose This study systematically reviewed research on behavioral interventions based on the information-motivation-behavioral skills (IMB) model to investigate specific intervention strategies that focus on information, motivation, and behavioral skills and to evaluate their effectiveness for people with chronic diseases. Methods A systematic review was conducted in accordance with the guidelines of both the National Evidence-based Healthcare Collaborating Agency and Im and Chang. A literature search was conducted using electronic databases. Randomized controlled trials that tested behavioral interventions based on the IMB model for promoting health behaviors among people with chronic diseases were included. Four investigators independently reviewed the studies and assessed the quality of each study. A narrative synthesis was used. Results A total of 12 studies were included in the review. Nine studies investigated patients with HIV/AIDS. The most frequently used intervention strategies were instructional pamphlets for the information construct, motivational interviewing techniques for the motivation construct, and instruction or role playing for the behavioral skills construct. Ten studies reported significant behavior changes at the first post-intervention assessment. Conclusion This review indicates the potential strength of the IMB model as a theoretical framework to develop behavioral interventions. The specific integration strategies delineated for each construct of the model can be utilized to design model-based interventions.Asian Nursing Research 08/2014; 8(3). DOI:10.1016/j.anr.2014.08.002 · 0.42 Impact Factor
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ABSTRACT: The sudden emergence of the AIDS epidemic in the 1980s created an urgent requirement to achieve rapid, voluntary, and sustained behavior change to protect individual and public health. Social psychologists, realizing the relevance of the research approaches and theoretical models that define the discipline, began applying existing research methodologies and conceptual models of attitude and behavior change and developed new models aimed at understanding, predicting, and promoting AIDS preventive behavior. This chapter explores the history of the AIDS epidemic, the unique behavior change challenges it poses, and the application of social psychological approaches in the fight against this disease. We review classical social psychological theories that have been applied to promote safer sex behavior change and describe a novel Information–Motivation–Behavioral Skills (IMB) conceptualization that was developed to strengthen efforts to understand, predict, and promote AIDS preventive behavior. The IMB model has been applied successfully to understanding and predicting AIDS risk and AIDS preventive behavior in diverse settings worldwide, and IMB model-based interventions have produced sustained improvements in AIDS preventive behavior in a wide variety of intervention settings. Applications of the IMB model across multiple health behavior domains, including the prediction and promotion of adherence to medical regimen, cardiac health, and diabetes self-management, have established the IMB model as a highly generalizable theoretical and applied approach to health behavior change.Advances in Experimental Social Psychology, Edited by J. Olson & M. Zanna, 01/2014: chapter Social psychology and the fight against AIDS: An Information-Motivation-Behavioral Skills model for the prediction and promotion of health behavior change: pages 105-193; Elsevier.
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ABSTRACT: Despite the well-documented relationship between depression and antiretroviral therapy (ART) nonadherence, few studies have identified explanatory pathways through which depression affects adherence. The current study tested lifestyle structure-the degree of organization and routinization of daily activities-as a mediator of this relationship, given previous evidence of lifestyle structure being associated with both depression and ART nonadherence. HIV-infected individuals starting or re-starting ART in the California Collaborative Treatment Group 578 study (n = 199) were assessed over 48 weeks. Adherence was measured using electronic monitoring caps to determine dose timing and doses taken, and viral load was assessed. The mediating role of lifestyle structure was tested using generalized linear mixed-effects modeling and bootstrapping. Lifestyle significantly mediated the relationship between depression and both measures of ART adherence behavior. Interventions that minimize disruptions to lifestyle structure and link adherence to daily activities may be useful for individuals with depression and ART nonadherence.AIDS and Behavior 05/2014; 19(1). DOI:10.1007/s10461-014-0802-3 · 3.49 Impact Factor