Pilot testing of an HIV medication adherence intervention in a public clinic in the Deep South

Abstract

Purpose: Strict adherence to HIV medications is critical to ensure long-term disease control, and adherence interventions that are possible in a clinic setting with limited resources are needed.

Data sources: This randomized controlled pilot study tested an adherence intervention guided by the Information-Motivation-Behavioral Skills (IMB) model. The intervention included HIV education, a peer video, motivational interviewing, and attention to behavioral skills including communication with providers and adherence-enhancing devices. Dependent variables included 3-4 week adherence recall, medication refill rate, changes in IMB subscale scores, appointment attendance, and HIV-associated laboratory findings. Seventy-three individuals starting or restarting antiretroviral therapy were enrolled and 56 were randomized.

Conclusions: Improvements were seen in most outcomes, with small to moderate effect sizes, but the study was not powered to show statistical significance. Threats to power included a 51% attrition rate, resulting mostly from loss to clinical care or prolonged gaps in care.

Implications for practice: A telephone-based intervention to improve HIV medication adherence shows promise. Further study is needed with greater attention to retention in care.

Figure 1

Information–motivation–behavioral skills model. Note. Adapted from Fisher et al. (2006). Reprinted with permission.

Figure 2

Recruitment and retention patterns of study participants (November 7, 2005, to October 3, 2006). Note. Adapted from Konkle-Parker et al. (2010, p. 93).

Figure 3

Illustration of flow of clinical trial. Note. TOFHLA, test of functional health literacy assessment; IMB, information–motivation–behavioral skills; CES-D, Center of Epidemiologic Studies-Depression.