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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- "However, only scant support for specific interventions has been found (Fogarty et al., 2002; Haddad et al., 2000; Haynes, McDonald, Garg, & Montague, 2002; Haynes, McKibbon, & Kanani, 1996; McDonald, Garg, & Haynes, 2002). Recently published data have shown some effects of group cognitiveÁbehavioral therapy (CBT) on changes in risk behavior (Kalichman, Rompa, & Cage, 2005), depressive symptoms, and social support (Carrico, Antoni, Weaver, Lechner, & Schneiderman, 2005) and modest effects on adherence (Wagner et al., 2006): First results of an individual psychotherapy intervention showed significant effects on adherence, as discussed in Weber et al. (2004). No data exist on meaningful factors or combination psychotherapy for successful behavior change. "
ABSTRACT: The aim of this exploratory study was to examine the possible mechanisms of behavioral change in a cognitive-behavioral intervention supporting medication adherence in HIV-infected persons. A total of 60 persons currently under medical treatment were randomized to psychotherapy or usual care and were compared with a sociodemographically matched group of general psychotherapy clients. Outcome measures included therapy adherence using medication event-monitoring system psychotherapeutic processes and changes of experience and behavior. The general psychotherapy group was initially more distressed than HIV psychotherapy patients and reached higher levels of psychotherapeutic effect. In the HIV psychotherapy patients, a significant effect was found for maintaining adherence to medical treatment (Weber et al., 2004). These findings show that psychotherapy is a beneficial intervention for HIV-infected persons, and therapeutic alliance and activation of resources do not differ from a general psychotherapy treatment. Differential effects were detected for specific process variables, namely problem actuation.Psychotherapy Research 10/2009; 20(2):203-13. DOI:10.1080/10503300903246663 · 1.75 Impact Factor
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ABSTRACT: Scientific rigor in intervention trials is frequently used in systems that identify effective interventions for dissemination. In these systems, and in work that synthesizes bodies of research, percent attrition is often considered a fatal threat to validity. However, differential attrition, versus percent total, is of primary concern. Key methodologic, design, and analytic issues pertaining to scientific rigor in longitudinal designs were identified, and the current literature on antiretroviral therapy adherence interventions (k = 51) was evaluated in relation to these. Although results suggest that this body of literature has progressed in rigor, improvements are needed in transparency of reporting participant flow, retention strategies, handling of missing data, and characterization of retained and lost cohorts. Attrition averaged 30% total, and differential by study arm was estimated at 9%. Differential attrition continues to be underreported and is not well represented by the more frequently used, though arguably less appropriate, metric of overall percent attrition.Current HIV/AIDS Reports 11/2008; 5(4):172-185. DOI:10.1007/s11904-008-0026-0
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ABSTRACT: This case study investigates the co-construction communication patterns that emerged during an Human Immunodeficiency Virus (HIV) intervention designed to reduce negative and critical self-talk. The transcripts of eight sequential acupressure and behavioral (SAB) counseling intervention sessions between a therapist and two medically nonadherent HIV-infected women were analyzed using Giorgi's (1989, 1994, 1997, 2006) phenomeonlogical method of inquiry. The analysis revealed three major themes: "assessing the present," "reviewing the past," and "forging the future," and eight subthemes: "safe atmosphere," "disclosure," "negotiating meaning," "releasing the past," "breaking the past-to-present pattern," "reducing uncertainty," "generating options," and "projecting images." Prior to the intervention sessions, the women reported experiencing negative and critical self-talk and inconsistent medication adherence. Self-talk and illness narrative modifications were evident within and across sessions as the therapist used sequential acupressure and behavioral counseling techniques. During the one month follow-up, the participants reported no experience of negative and critical self-talk and described actions taken toward goals discussed and imagined during the intervention such as medication adherence, exercise, and reenrollment in school. The co-construction themes that emerged in the intervention were consistent with findings in the comforting message literature with specific parallels to the factor analysis findings of Bippus (2001). This work lends support to comforting message research and suggests that distinctions between everyday comforting messages and chronic illness support strategies may be more similar than anticipated. Other study conclusions include clinical and practical implications for people working with HIV-infected individuals.