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Select Abstracts from Elements of Success: An International Conference on Adherence to Antiretroviral Therapy, December 4-7, 2003, Dallas, Texas, USA

Background: The purpose of this study was to evaluate the effectiveness of a nursing telephone intervention to help persons with HIV manage their adherence to HIV medications. The specific aim of the study was to test the hypothesis that there would be no difference in medication adherence between participants randomly assigned to receive usual patient education and support from clinic staff (the control group), and the intervention group to receive, in addition to the usual patient education and support, a telephone call (once a week for 12 weeks) that provides an individualized program of education, community referrals, and counseling. Methods: Participants were recruited by their caregivers (n=95), had the study explained to them, and gave informed consent. Adherence was measured by electronic caps and by self-report, as well as viral loads and CD4 counts. Participants were assigned to the intervention or control treatment group. Results: This was a Repeated Measures Design and follow-up data were difficult to collect because of difficulty in maintaining communication with participants over the four months of the study. Many subjects recruited at baseline were dropped from all analyses due to incomplete data, resulting in a sample size of 17 in the intervention group and 24 in the control group. For this reason, generalizations to the population of HIV subjects should not be made. Significant differences between groups within time point, or between time points within group were found for adherence using the cap as a measurement tool, viral load, CD4 counts, and adherence using the self-report as the measurement tool. The intervention group had significantly lower mean viral loads than the control group at both time point 1 (p = 0.0003) and time point 2 (p = 0.0030). For CD4 counts, differences between the intervention and control groups were seen. At time point 3 (p = 0.0021) the intervention group had significantly higher mean CD4 counts than the control group. Conclusions: In future research, phone disconnections will be countered with letters and with mailed phone cards. The researchers are developing the strategy of a closer working partnership with the clinic staff who make the appointments and who often have a relationship with the patients. Suggestions for future intervention strategies include the provision of cell phones for participants.