Prospective, randomized, two-arm controlled study to evaluate two interventions to improve adherence to antiretroviral therapy in Spain

Abstract

Context: Proper adherence is essential to obtain the desired results of antiretroviral therapy; thus, new interventional strategies for this purpose must be sought.

Objective: Comparison of 2 interventions, one conducted by a health professional and the other by a peer (patient on antiretroviral therapy), to improve adherence to antiretroviral therapy.

Design and setting: In 2003, a randomized, concurrent, follow-up study was conducted at 3 hospitals.

Participants: Patients were recruited consecutively at infectious disease visits scheduled to monitor their disease from May to September 2003. A sealed envelope was used to assign patients to each intervention group. A previous phase was conducted to unify data collection, and the intervention consisted of 4 visits at weeks 0, 8, 16, and 24.

Results: Among the 240 patients included, 198 completed follow-up, and in 11 of these, treatment was interrupted at the doctor's decision. At baseline, 46.8% were classified as adherent. Multilevel analysis showed that as the visits progressed, the probability of adhering to treatment increased (OR 1.23; P<.01). Although differences were not significant, the group treated by a peer showed better results than the group treated by a health professional (OR 1.60; P=0.25). A lower probability of antiretroviral adherence was observed in patients receiving a drug combination including a protease inhibitor (OR 0.27; P<0.01) and in those with psychological distress (OR 0.44; P=0.03). Patients with a higher score on the physical quality of life index (OR 1.05; P<0.01) presented a higher probability of adherence.

Conclusions: The psychoeducational intervention studied is viable and effective for improving antiretroviral adherence. When the intervention is conducted by a peer the results are at least as good as those obtained by a health professional, and this implies cost-saving for the health system.