Motivating HIV Positive Women to Adhere to Antiretroviral Therapy and Risk Reduction Behavior: The KHARMA Project

Abstract

Women comprise the fastest growing group of persons with AIDS. They are often diagnosed later in the disease, when antiretroviral therapy (ART) is strongly indicated. Antiretroviral therapy has transformed the course of HIV/AIDS to a treatable, chronic illness. This article provides a profile of women with HIV/AIDS and describes ART. Selected research related to adherence and motivation is summarized. Psychosocial and economic concerns specific to women, ART, adherence, and motivation are presented. The article reviews challenges for risk reduction behaviors for HIV + women, such as sexual activity and substance abuse. The authors discuss the Keeping Health and Active with Risk reduction and Medication Adherence (KHARMA) Project, a research project in progress that was designed to promote adherence to both ART and risk reduction behaviors in HIV+ women. The study includes two groups: a motivational group intervention based on motivational interviewing and a health promotion program control group tailored to the needs of HIV+ women. A description of the tailored intervention and project update is included.

Applying Behavioural Insights to HIV Prevention and Management: a Scoping Review

“…Another example was a clinical trial to test the effect of a nurse-led motivational group intervention on adherence to ART and risk reduction behaviours among women living with HIV in the USA. The nurse facilitators used motivational interviewing techniques to explore discrepancies between current behaviours and values [ 50 ]. Other messengers included hospitals and well-known/respected sites to improve adherence to treatment, and care and case managers to facilitate recruitment into the programme and HIV care (Table 2 ).…”

“…This included participants attending motivational interviewing sessions with a psychologist or a specialist nurse [ 169 , 182 , 194 ], and participants regularly receiving carefully crafted motivational messages to target their ego to influence their health behaviours, for example messages such as ‘Stay strong!’, ‘Have courage!’, or ‘Don’t give up!’ [ 147 , 155 ]. A study aimed to evoke positive emotions in PLWHIV for maintaining their HIV care and management, for example by providing them with opportunities to participate in non-medical-related leisure activities, such as massage therapy and beauty consultancy, alongside their HIV intervention sessions [ 146 ]. Other examples involved participants receiving HIV education and cognitive behavioural skills-building sessions to affect their ego through empowering them with HIV knowledge and management skills to look after their health and wellbeing (Table 2 ).…”

“…Other examples include text-based ART medication reminders and mindfulness exercises to reduce HIV viral load (Table 2). Culturally relevant and gender-specific messaging to engage in HIV prevention [30,101] Loss framed lottery intervention to encourage dual contraception methods to prevent HIV infection [86] HIV to take PrEP medication [142] HIV management Use of priming stimuli that is empowering or culturally meaningful to improve adherence to ART and retention in care [143,144] Use of financial rewards as priming to improve adherence to ART and to suppress viral load count [49,145] Providing safe sex materials as priming to practice safe sex to prevent HIV transmission [146] Personalised cues and reminder messages for remembering dose times to support ART adherence [72,74,147,148] Affect HIV prevention Creating positive emotion for HIV testing or accessing HIV services [111,139,149,150] Peer-led group sessions to learn skills for self-efficacy and positive sexual health behaviours [31] Increasing risk perception towards HIV to encourage HIV prevention behaviours [99,151] HIV management Creating positive emotion for HIV care retention and ART adherence through social, financial, or non-financial support [99,111,143,146] Group sessions targeting positive affect to increase skills for self-efficacy to encourage ART adherence and viral load suppression [146,[152][153][154] Motivational messages to encourage ART adherence [147,150,155] Commitment HIV prevention Use of binding contracts with financial deposits to encourage HIV testing or clinic visits [139,[156]…”

“…In one study, patients would receive congratulations for attending the clinic three consecutive on-time visits for HIV care, and they were given a sticker to proudly place on an interactive poster publicly displayed in the clinic to celebrate and acknowledge their achievement [143]. Another study involved a multi-component positive affect intervention for MSM who used drugs, eight core skills, and meditation exercises were delivered to them to increase positive affect among HIV management Use of non-explicit commitment devices in the form of financial incentives for ART adherence and viral load suppression goal in the future [108,144,147,154,[169][170][171][172][173][174][175][176][177][178][179][180][181] Use of non-explicit commitment devices in the form of financial incentives to meet HIV testing, linkage to HIV care and clinic attendance goal in the future [172,182,183] Use of non-explicit commitment devices in the form of non-financial incentives for ART adherence and viral load suppression goal in the future [74,147,155] Use of non-explicit commitment devices in the form of non-financial incentives to meet HIV testing, linkage to HIV care and clinic attendance goal in the future [117,143,146,[184][185][186] Ego HIV prevention HIV education sessions alongside financial education programmes to target ego and self-efficacy [18,31,99,[187][188][189] HIV education sessions and peer support to target ego and increase HIV risk perception ...…”

“…[147,155]. A study aimed to evoke positive emotions in PLWHIV for maintaining their HIV care and management, for example by providing them with opportunities to participate in nonmedical-related leisure activities, such as massage therapy and beauty consultancy, alongside their HIV intervention sessions [146]. Other examples involved participants receiving HIV education and cognitive behavioural skills-building sessions to affect their ego through empowering them with HIV knowledge and management skills to look after their health and wellbeing (Table 2).…”