Adapting and Testing an Evidence-Based Antiretroviral Medication Adherence Intervention in China

Thursday, 25 July 2013: 3:15 PM

Ann Bartley Williams, EdD, RN
School of Nursing, University of California Los Angeles, Los Angeles, CA
Hong Hong Wang, PhD, RN
School of Nursing, Xiangya School of Nursing, Central South University, Changsha, China
Xian Hong Li, PhD, RN
Xiangya School of Nursing, Central South University, Changsha, Hunan, China
Kristopher P. Fennie, MPH, PhD
Robert Stempel School of Public Health, Florida International University, Miami, FL
Jane Burgess, MS, RN, ACRN
Department of Veterans Affairs, Los Angeles, CA

Learning Objective 1: The learner will be able to discuss key steps in cross-cultural adaptation of an evidence-based nursing intervention.

Learning Objective 2: The learner will understand the impact of a home visit nursing intervention on medication adherence among people living with HIV/AIDS in south central China.

Purpose: To test the effectiveness of a culturally adapted evidence-based home nursing intervention to improve adherence to antiretroviral medications among people living with HIV/AIDS (PLWH/A) in Hunan, China.

Methods: In a randomized, controlled trial, 114 subjects were assigned to receive a culturally adapted intervention consisting of monthly visits and interim phone calls plus standard care or standard care alone. The intervention previously demonstrated efficacy in a randomized clinical trial conducted in the United States. All subjects were residents of Hunan, China, living with HIV/AIDS and self-reporting less than 90% adherence to prescribed medications. Measures included a 7-day visual analogue medication adherence scale, a social support rating scale, the Chinese version of the Center for Epidemiological Studies Depression scale Chinese, and an HIV/AIDS stigma scale. Data were collected in structured face-to-face interviews at baseline, 6 months, and 12 months at the time of a regularly scheduled clinical visit. Information regarding ARV regimen, treatment duration, time of diagnosis, CD4 count and HIV-RNA was extracted from the medical record.

Results: Subjects were 72% male (N=82); 52% (N=59) married; and only 28% (N=32) stably employed. Thirty-one percent (N=35) reported past or current drug abuse. The great majority (98%) had a CD4 count at baseline that was less than 350 cells/mm3. At 6 months and 12 months, a greater proportion of subjects in the intervention group self-reported  adherence greater than 90% compared to the control group.  The difference over time is significant (Extended Mantel-Haenszel Test:  8.8, p=.003).

Conclusions: In spite of significant cultural differences, evidence-based interventions can be implemented effectively in new settings and with new populations.