Paper
Monday, November 14, 2005
Sustaining Medication Adherence in Patients with HIV/AIDS
Judith A. Erlen, RN, PhD, FAAN1, Susan Sereika, PhD2, Mary Pat Lewis, PhD, RN3, Jacqueline Dunbar-Jacob, PhD, RN, FAAN2, Susan Hunt, MD4, Christopher M. Ryan, PhD2, and John Mellors, MD4. (1) University of Pittsburgh School of Nursing, Pittsburgh, PA, USA, (2) Department of Health and Community Systems, Biostatistics, and Epidemiology, SON and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA, (3) c/o J. Erlen, University of Pittsburgh, Pittsburgh, PA, USA, (4) CRCD, Pittsburgh, PA, USA
| Learning Objective #1: Discuss the prevalence of medication non-adherence and attrition involved in adherence and intervention research with HIV/AIDS patients |
| Learning Objective #2: Appreciate the importance of monitoring adherence to the treatment protocol when evaluating outcomes in adherence research |
Research with HIV/AIDS patients has focused mainly on identifying patterns of interventions to improve medication adherence. This research (R01 NR04749; P30 NR03924) addresses sustaining adherence beyond the length of the intervention. The purpose of the study was to examine the effect of a nurse delivered 16 week tapered telephone maintenance program based on social cognitive theory to antiretroviral therapy relative to usual care/control condition. The sample at baseline included 200 randomly assigned subjects with HIV/AIDS. Subjects were 67% males and 54% white; mean age was 40.6 years. Adherence was measured using electronic event monitors (EEMs) with insertion of events from diaries when patients “pocket dosed”. Intent-to-treat approach using repeated measures analysis was used to assess adherence over time. Fifty-five (28%) subjects dropped out of the study between baseline and post-maintenance, with similar rates in the treatment and the control groups. While the intervention group showed modest improvement in change scores from post-intervention to post-maintenance, there were no significant differences between the control and intervention groups for adherence defined as prescribed doses, compliant days, missed days, optimum interval, and correct day and interval. The maximum number of maintenance sessions was eight; not all subjects received the total number of sessions. The mean number of maintenance sessions delivered was 5.2±3.3 sessions. Thirty-seven (38.9%) received all sessions; 23 (24.2%) did not receive any maintenance sessions. The lack of significant differences between groups may be due to the fact that all intervention subjects did not receive the full maintenance program. This study shows that attrition is difficult to prevent in a longitudinal study with HIV/AIDS subjects. Researchers need to identify issues related to attrition and develop strategies to minimize their effect when conducting a longitudinal study. In addition, there is a need to monitor adherence to the research protocol during an intervention study.