Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2000 Dec;15(12):841-7.
doi: 10.1046/j.1525-1497.2000.00127.x.

Cue-dose training with monetary reinforcement: pilot study of an antiretroviral adherence intervention

M O Rigsby  1 , M I Rosen, J E Beauvais, J A Cramer, P M Rainey, S S O'Malley, K D Dieckhaus, B J Rounsaville
Affiliations
Clinical Trial

Cue-dose training with monetary reinforcement: pilot study of an antiretroviral adherence intervention

M O Rigsby et al. J Gen Intern Med. 2000 Dec.

Abstract

Objective: To assess the feasibility and efficacy of two interventions for improving adherence to antiretroviral therapy regimens in HIV-infected subjects compared with a control intervention.

Design: Randomized, controlled, pilot study.

Setting: Department of Veterans Affairs HIV clinic and community-based HIV clinical trials site.

Participants: Fifty-five HIV-infected subjects on stable antiretroviral therapy regimens. Subjects were predominantly male (89%) and African American (69%), and had histories of heroin or cocaine use (80%).

Interventions: Four weekly sessions of either nondirective inquiries about adherence (control group, C), cue-dose training, which consisted of the use of personalized cues for remembering particular dose times, and feedback about medication taking using Medication Event Monitoring System (MEMS) pill bottle caps, which record time of bottle opening (CD group), or cue-dose training combined with cash reinforcement for correctly timed bottle opening (CD+CR).

Measurements: Opening of the pill bottle within 2 hours before or after a predetermined time was measured by MEMS.

Results: Adherence to the medication as documented by MEMS was significantly enhanced during the 4-week training period in the CD+CR group, but not in the CD group, compared with the control group. Improvement was also seen in adherence to antiretroviral drugs that were not the object of training and reinforcement. Eight weeks after training and reinforcement were discontinued, adherence in the cash-reinforced group returned to near-baseline levels.

Conclusions: Cue-dose training with cash reinforcement led to transient improvement in adherence to antiretroviral therapy in a population including mostly African Americans and subjects with histories of drug abuse. However, we were not able to detect any sustained improvement beyond the active training period, and questions concerning the timing and duration of such an intervention require further study. Randomized, controlled clinical studies with objective measures of adherence can be conducted in HIV-infected subjects and should be employed for further evaluation of this and other adherence interventions.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Mean adherence to primary medication for treatment groups and controls. (+) indicates significant (P < .05) differences from control group value at indicated week; C, control, CD; cue-dose training; CD+CR, cue-dose training plus cash reinforcement.
FIGURE 2
FIGURE 2
Mean adherence to nonprimary medications for treatment groups and controls. Adherence to other antiretroviral medications increased in CD+CR group and remained numerically higher throughout the study period compared with controls. C indicates control, CD; cue-dose training; CD+CR, cue-dose training plus cash reinforcement.
FIGURE 3
FIGURE 3
Zidovudine (ZDV) levels compared to time interval between phlebotomy and last MEMS-documented bottle opening. Zidovudine levels for all time points were consistent with known pharmacokinetics of zidovudine.
See this image and copyright information in PMC

Comment in

References

    1. Ioannidis JPA, Sacks HS, Cappellen JC, et al. Presented at the Fourth Conference on Retroviruses and Opportunistic Infections. Washington, DC: 1997. Clinical efficacy of antiretroviral changes in treatment-experienced HIV-infected patients: a meta-analysis.
    1. Hammer SM, Squires KE, Hughes D, et al. A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. N Engl J Med. 1997;337:734–9. - PubMed
    1. Cameron DW, Heath-Chiozzi M, Danner S, et al. Randomized placebo-controlled trial of ritonavir in advanced HIV-1 disease. Lancet. 1998;351:543–9. - PubMed
    1. Haynes RB, McKibbon KA, Kanani R. Systematic review of randomized trials of interventions to assist patients to follow prescriptions for medications. Lancet. 1996;348:383–6. - PubMed
    1. Patterson DL, Swindels S, Mohm JA, et al. Adherence with protease inhibitor therapy for human immunodeficiency virus infections. Presented at the 38th Interscience Conference on Antimicrobial Agents and Chemotherapy. San Diego. 1998. Calif.

Publication types

Substances