Multidisciplinary HIV Adherence Intervention: A Randomized Study

Levy, R; Rayner, Craig R.; Fairley, Christopher K.; Kong, David C M; Mijch, Anne M; Costello, Kathleen; McArthur, Colin

doi:10.1089/apc.2004.18.728

Cited by 57 publications

(63 citation statements)

References 16 publications

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“…In our study, participation in multidisciplinary activities offered by health-care services served as a protective factor against non-adherence suggesting that involving different health professionals favors treatment and the assessment of different aspects of health care. Some studies have addressed characteristics of health-care services and multidisciplinary strategies aimed at adult patients, stressing the positive impact of a multidisciplinary team, on adherence and disease control indicators (Bonolo et al, 2005;Dieckhaus & Odesina, 2007;Frick, Tapia, Grant, Novotny, & Kerzee, 2006;Levy et al, 2004;Nemes, Carvalho, & Souza, 2004).…”

Section: Discussionmentioning

confidence: 99%

Antiretroviral treatment adherence in childhood and adolescence: Multidisciplinary team as an associated factor in Brazil

et al. 2013

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Our aim was to analyze factors associated with non-adherence to antiretroviral (ARV) treatment among children and adolescents. A cross-sectional study was carried out involving non-institutionalized children and adolescents between 2 and 20 years of age, addressing non-adherence to ARV treatment, which was defined as taking ≤89% of the medications on the day of the interview and the three previous days. The investigation into the association between non-compliance and the variables of interest was performed using unconditional logistic regression. The independent factors associated with non-adherence were forgetfulness (OR = 3.22; 95%CI = 1.75-5.92), difficulties coping with treatment (OR = 2.65; 95%CI = 1.03-6.79), and living with grandparents (OR = 2.28; 95%CI = 1.08-4.83), whereas a protective effect was found with participation in multidisciplinary activities (OR = 0.49; 95%CI = 0.25-0.96), i.e., this factor indicates that the exposure to the variable is beneficial, promoting adherence. We concluded that forgetting to take the medications and reporting having difficulty coping with ARV treatment are potentially modifiable factors through educational and programmatic actions. Residing with one's grandparents may strongly impact adherence to ARV treatment, indicating the need for the systematic support of these family members. Participation in multidisciplinary activities should be stimulated at health-care services.

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Section: Discussionmentioning

confidence: 99%

Antiretroviral treatment adherence in childhood and adolescence: Multidisciplinary team as an associated factor in Brazil

et al. 2013

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“…While drug level monitoring provides an objective value, it is impractical and potentially quite expensive depending on the number of drugs measured. Additionally, the level probably represents short-term adherence rather than day-to-day (Deschamps et al, 2004;Levy et al, 2004). However, non-adherence can still be very difficult to diagnose, leading to unnecessary ARV changes due to presumed HIV resistance.…”

Section: Discussionmentioning

confidence: 99%

“…In clinical practice, adherence is typically assessed through interview and pill counts. More intensive measures such as MEMS™ caps or drug level monitoring may be used for more accurate information and in clinical trials (Deschamps et al, 2004;Levy et al, 2004). However, non-adherence can still be very difficult to diagnose, leading to unnecessary ARV changes due to presumed HIV resistance.…”

Section: Discussionmentioning

confidence: 99%

Virologic Response Using Directly Observed Therapy in Adolescents With HIV: An Adherence Tool

Purdy

Freeman²,

Martin³

et al. 2008

Journal of the Association of Nurses in AIDS Care

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Virologic response to highly active antiretroviral therapy (HAART) treatment of human immunodeficiency virus (HIV) infection depends on viral sensitivity to antiretrovirals (ARV's) and excellent medication adherence. Adolescents with vertically-acquired HIV may require complicated regimens due to significant treatment experience and often have poor medication adherence. A retrospective chart review identified five adolescents with vertically acquired HIV and plasma HIV viral load rebound or nonresponse on a stable HAART regimen followed by a period of directly observed therapy (DOT) in a clinic or hospital setting with serial viral load measurements. Four subjects had a virologic response (mean decline 1.15 log) after DOT. A response to HAART can be seen despite ARV resistance using DOT, and treatment-experienced patients seemingly unresponsive to HAART may be non-adherent even with reassuring adherence measures. A period of clinicmonitored DOT may allow diagnosis of non-adherence, discussion of medication barriers and avoidance of unnecessary medication changes. KeywordsHIV/AIDS; Directly Observed Therapy; adolescence; adherence; virologic response Highly active antiretroviral therapy (HAART) is remarkably effective in suppressing HIV replication, preventing opportunistic infections, and prolonging life in children and adults with HIV infection (Gortmaker et al., 2001;Palella et al., 1998). However, the success of HAART Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. (Watson & Farley, 1999). NIH Public AccessAdherence to medications is often difficult in the pediatric population for reasons generally related to the developmental stage of the patient. In younger children, poor medication tolerability and palatability, lack of available liquid formulations for some medications, and caregiver non-adherence hinder adherence.In the adolescent population, psychosocial factors contribute greatly to non-adherence to antiretrovirals (ARVs), and often adolescents are given independence in taking medications despite not fully understanding their regimens (Martin, Elliot, Toledo-Tamula, Wolters, & Wood, 2004;Murphy et al., 2003). However, data on adherence to ARVs in vertically-infected adolescents are limited. In a study by Van Dyke et al., 2002, almost one-third of 125 HIVinfected pediatric subjects, most of whom were not adolescents, reported non-adherence to ARVs over the course of one year. Only 41% of a group of 161 HIV-positive adolescents infected via sexual contact or drug injection reported full ARV adherence (Murphy et al., 2003).Although adolescents with behavi...

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“…Although not targeted at Latinos, given the rarity of such studies, they need further discussion. Levy and colleagues 11 evaluated the impact of a multidisciplinary HIV adherence intervention for patients attending an ambulatory clinic at a large public hospital using both generalized education conducted by the study pharmacist and/or nurse and individualized follow up. Using multiple observations, they reported a significant decrease in self-reported number of missed doses for 4-, 7-, and 28-day time periods and a decrease in Morisky score, indicating an improvement in medication-taking behavior before and after the intervention.…”

Section: Adherence Enhancement Programmentioning

confidence: 99%

Effects of a Treatment Adherence Enhancement Program on Health Literacy, Patient–Provider Relationships, and Adherence to HAART among Low-Income HIV-Positive Spanish-Speaking Latinos

Servellen¹,

Nyamathi²,

Carpio

et al. 2005

AIDS Patient Care and STDs

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The impact of an adherence enhancement program for low income HIV-infected Spanishspeaking Latinos on health literacy, patient-provider relationships, and adherence to HAART was examined. Evaluations were conducted at baseline, 6 weeks, and 6 months for participants (n ‫؍‬ 85) randomly assigned to either the intervention group or a comparison group; 69 (81%) remained in the study for the entire 6-month duration. The intervention group scored significantly better than the comparison group on 3 of 5 measures of HIV health literacy at 6 weeks and on 2 of 5 measures, at 6 months. While there was a weak trend for the intervention group to report an increase in self-efficacy of medication adherence management, baseline to 6 weeks, no other changes were significant. Perceptions of the quality of relationship and communications with their HIV-treating physicians improved both at 6 weeks (p ‫؍‬ 0.04) and at 6 months (p Ͻ 0.001). The comparison group showed little change baseline to 6 weeks and baseline to 6 months. While there was a trend for the pilot group to report better medication adherence, these differences were not statistically significant. Further evaluation of the impact of this adherence enhancement program is needed. 745

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Multidisciplinary HIV Adherence Intervention: A Randomized Study

Cited by 57 publications

References 16 publications

Antiretroviral treatment adherence in childhood and adolescence: Multidisciplinary team as an associated factor in Brazil

Antiretroviral treatment adherence in childhood and adolescence: Multidisciplinary team as an associated factor in Brazil

Virologic Response Using Directly Observed Therapy in Adolescents With HIV: An Adherence Tool

Effects of a Treatment Adherence Enhancement Program on Health Literacy, Patient–Provider Relationships, and Adherence to HAART among Low-Income HIV-Positive Spanish-Speaking Latinos

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