Sociobehavioral interventions may improve ART adherence among general populations with HIV

Behavioral interventions led to improved antiretroviral therapy adherence in more than half of the multinational studies reviewed in a comprehensive analysis and presented this week at the meeting of the International Association of Physicians in AIDS Care.

The findings were presented by Damien Rzeznikiewiz, of St. Michael’s Hospital in Toronto.

“We conducted a systematic review of 43 studies involving a broad range of interventions, including motivational, behavioral, incentive-driven and medication management interventions,” he said. “We were looking for programs that directly or indirectly targeted adherence, and ones that were aimed only at patients, not providers or health care systems.”

Rzeznikiewiz said that the interventions were delivered by pharmacists, nurses, peers with HIV and health advocates. Virologic and immunologic data were reported, as were data from an analysis of intervention features.

“Individually-delivered interventions were 47% more successful than those delivered to groups,” Rzeznikiewiz said. “Interventions with a duration of 12 weeks or more were 30% more successful than those not lasting that long. Medication management interventions were 30% more successful than all others.”

Rzeznikiewiz said that previous data indicated that about 10% of adherence interventions aimed at specific populations like men who have sex with men were successful, and that that figure has increased to about 39%. “However, adherence intervention programs targeted to all populations, and not just these marginalized groups, are still more successful, according to our findings.”

Rzeznikiewiz said that there were no associations between improved adherence and the type of provider, the frequency of visits to the provider or clinic, ART experience of patients, the delivery setting or the targeting of patients reporting poor adherence at baseline.

“Many of my patients do not know why they take their medications, how to manage side effects, what to eat before they take their medications, and so forth,” Rzeznikiewiz said. “Teaching them how to deal with these things improves adherence.” — by Rob Volansky