Table 1.
Recent studies of behavioral interventions to promote antiretroviral adherence
| Study | Outcomes |
|---|---|
| Deering et al. [19], 2009 | Adherence: |
| Location:Vancouver, BC, Canada | Self-report: yes |
| Sample: n = 20; W; ART-N + ART-E; community sample with current and/or past injection or other drug use, housing instability, sex work | Pharm refills: no |
| Facilitator/modality: Community facilitator/drop-in nurse consult; in person (group and individual) | VL: yes |
| Strategies: Peer-dyads (1 trained peer and 1 matched peer) attended facilitated group sessions (targeting health, wellness, and education in the areas of positive living, safe disclosure, side effects, depression, and nutrition); peer-dyads set medical/social support goals after group sessions; capacity building for peer health advocates; drop-in nurse consultation service | CD4: N/A |
| Intensity: Weekly hour-long small group and peer-dyad meetings (minimum of 6 months); nurse consults as initiated | |
| DiIorio et al. [22], 2008 | Adherence: |
| Location: Southeastern Metropolitan Area, United States | EDM: yesa |
| Sample: n = 246; M and W; ART-N + ART-S; clinic population | VL: no |
| Facilitator/modality: Nurses in motivational interviewing/in person (phone if needed) | CD4: no |
| Strategies: Individual sessions exploring barriers/facilitators of adherence, strategies to improve adherence, and development of action plans | |
| Intensity: 11 one-on-one sessions (~ 20–90 min) with phone support over 4 months | |
| Hirsh et al. [12•], 2009 | Adherence: |
| Location: California, United States | Claim records: yes |
| Sample: n = 10 pharmacies, 7018 Medi-Cal beneficiaries; M and W; ART-S + ART-E | VL: N/A |
| Facilitator/modality: Pharmacists/in person | CD4: N/A |
| Strategies: Individual face-to-face at time of refill with services for adverse reactions, assessment of adherence, linkage to clinical team and case manager, and recommendations for changes to regimen as needed | |
| Intensity: Average of 14 visits over 1 year | |
| Johnson et al. [25], 2007 | Adherence: |
| Location: Los Angeles, CA; Milwaukee, WI; New York, NY; San Francisco, CA | Self-report: yesa |
| Sample: n = 204; M and W; ART-E; clinic and community sample with high-risk behavior | VL: N/A |
| Facilitator/modality: Trained facilitators/ in person | CD4: N/A |
| Strategies: Individual one-on-one with facilitator focusing on 1) coping, positive affect, and social support; 2) self-regulation issues, safer sex, safer drug use, and status disclosure; and 3) accessing health services, medication adherence, and medical decision making | |
| Intensity: 15 (90-min) sessions delivered over 15 months | |
| Koening et al. [27], 2008 | Adherence: |
| Location: Atlanta, GA | EDM: yesa |
| Sample: n = 226; M and W; ART-N; clinic population with an identified adherence support person | VL: yes |
| Facilitator/modality: Nurse and peer/in person, telephone, group meetings | CD4: no |
| Strategies: Individual sessions (with and without peer support) aimed at identifying and solving adherence-related barriers via increased ART-related knowledge, improving recognition of mental health and support related issues, and improving prospective memory; support calls utilized an abbreviated procedure; multipatient educational groups provided ongoing adherence support outside of clinic visits | |
| Intensity: Six individual sessions were delivered pre-(2 sessions ~ 2–3 h each) and post-(4 sessions ~ 1.5 h each) ART initiation; post initiation 5 phone support calls were placed by nurse interventionist between individual sessions; group sessions; adherence support peers could attend all individual and group sessions but were required to attend one meeting prior to initiation and one of the first two meetings post initiation | |
| Lopez et al. [26], 2007 | Adherence: |
| Location: Miami, FL; New York, NY; Newark, NJ | Self-report: yesa |
| Sample: n = 228; W; ART-E; mixed in terms of substance use history (current use, former use, never having used) | VL: yesa |
| Facilitator/modality: Therapist trained in motivational interviewing and CBT, content-relevant professional (eg, pharmacist, nutritionist, etc.)/individual, group, in person, via video | CD4: N/A |
| Strategies: A multicomponent intervention focusing on substance use, nutrition, and positive living-related factors; adherence component used a problem-solving focus to address the importance of and challenges in attaining high levels of adherence, viral resistance | |
| Intensity: 10-session intervention (phase I) and six sessions of behavioral exercises (phase II); participants were assigned to receive all sessions either individually or in a group format; intervention content was then randomized to be delivered via high-intensity (dyadic presentations, in person attention) or low-intensity (video-based and educational print materials) condition across all intervention content areas [31] | |
| Simoni et al. [20], 2009 | Adherence: |
| Location: Seattle, WA | Self-report: yesa |
| Sample: n = 224; W and M; ART-N + ART-S ; clinic population | EDM: no |
| Facilitator/modality: Peers, group facilitators with graduate training in psychology/group meetings, telephone calls, pager messages | VL: yesa |
| Strategies: Facilitated peer support group meetings twice monthly with weekly individual telephone contacts in which peers assessed barriers to adherence and provided social support, strategies, and referrals. Two-way pagers with automated text messages to cue doses and offer education and entertainment | CD4: yesa |
| Intensity: For 3 months, 1-h meetings twice a month and weekly telephone calls; pagers with messages sent daily for the first 2 months and then tapered last month | |
| Parsons et al. [23], 2007 | Adherence: |
| Location: New York, NY | Self-report: yesa |
| Sample: n = 147; W and M; ART-E; clinic and community sample with current history of hazardous drinking | VL: yesa |
| Facilitator/modality: Masters-level counselor/one-on-one counseling | CD4: yesa |
| Strategies: Individual counseling sessions focused on factual information, increasing personal responsibility for adherence and hazardous drinking, developing a personalized plan and skills to address adherence-related and drinking-related challenges, identifying antecedents to adherence-related and drinking-related risk behaviors, relapse prevention, and linkage to related support services | |
| Intensity: A total of 8 (60 min) sessions were delivered approximately weekly (had up to 12 wk to complete) | |
| Pearson et al. [21], 2007 | Adherence: |
| Location: Beira, Mozambique | Self-report: yes |
| Sample: n = 350; W and M; ART-N; clinic population | VL: N/A |
| Facilitator/modality: Peer-delivered; individual | CD4: No |
| Strategies: Peer-facilitated modified Directly Observed Therapy at the clinic Monday through Friday (ART self-delivered over the weekends) with the addition of structured discussions initiated by the peer concerning social support, information, stigma, adherence, general encouragement, and linkage to community resources | |
| Intensity: 6 weeks of modified Directly Observed Therapy (Monday through Friday), visits averaged 15 min | |
| Reynolds et al. [24], 2008 | Adherence: |
| Location: Universities of Ohio State, North Carolina, Pennsylvania, Washington, and Nebraska | Self-report: yes |
| Sample: n = 109; W and M; ART-N + ART-S; clinic population | VL: N/A |
| Facilitator/modality: Nurse delivered; individual-based and telephone-based counseling | CD4: N/A |
| Strategies: Individually delivered intervention that started as in person then switched to a 24-h telephone-based support system providing education, enhanced motivation, and support; sessions including assessing knowledge, suggesting skills and strategies, proving reassurance, and working to improve coping with strong affect | |
| Intensity: 14 sessions over 16 weeks; calls placed 1/wk (~ 7.9 min) for weeks 1–12 and 14–16 | |
| Sabin et al. [28], 2009 | Adherence: |
| Location: Dali, Yunnan Province, China | EDM: yes |
| Sample: n = 68; W and M; ART-E; clinic population | VL: no |
| Facilitator/modality: Nurse or provided/in person | CD4: no |
| Strategies: Patients with EDM-detected adherence<95% over the previous month received counseling that included a printout of the EDM data, review of adherence patterns, exploration of reasons for missed or off-time doses, identification of barriers, and discussion of strategies to improve adherence | |
| Intensity: 10–15 min sessions over 6 months | |
| Sampaio-Sa et al. [17], 2008 | Adherence: |
| Location: Salvador, Brazil | Self-report: no |
| Sample: n = 107; W and M; ART-N; clinic population | Pharmacy refill: no |
| Facilitator/modality: Co-facilitators (psychologist and social worker)/group meetings | VL: no |
| Strategies: Small group-based educational workshops covered information, adherence barriers, health promotion, and behavioral skills including social support, addressing barriers, stress management, self-monitoring, and relapse prevention | CD4: no |
| Intensity: Weekly 2–3 h workshops for 4 wk | |
| Whol et al. [18], 2009 | Adherence: |
| Location: Los Angeles County, CA | Self-report: no |
| Sample: n = 168; W and M; ART-N + ART-E; clinic population | VL: N/A |
| Facilitator/modality: Intensive adherence case management/in person | CD4: N/A |
| Strategies: Case management sessions including the identification of structural and personal barriers to adherence, the development of an individualized adherence plan, provision of strategies, goal setting, and appropriate referrals | |
| Intensity: Weekly sessions (~ 23 min) over 6 months |
Studies published in English language between September 1, 2007 and October 31, 2009.
ART antiretroviral therapy; ART-E ART experienced; ART-N ART naïve; ART-S switching ART regimens; CBT cognitive-behavioral therapy; EDM electronic dose monitoring; M men; N/A not available either because they were not assessed or were assessed but outcomes were not reported; VL viral load; W women
a
Support found but qualified by a modification to the analysis (eg, specific group, one but not all measures, or one but not all time intervals)