October 30, 2009

Common Support Schemes Failed to Increase Adherence Over the Long-Term

Programs developed to support the correct and regular dosing of antiretroviral (ARV) therapy among people living with HIV may not be as effective as experts might have hoped, according to a sobering study published online October 28 in the Journal of Acquired Immune Deficiency Syndromes. Neither peer support or pager reminders significantly boosted adherence rates in a University of Washington study conducted in Seattle.  

All of the ARVs are vulnerable to failure if drug-resistant virus emerges. In clinical studies, poor adherence is one of the primary reasons for drug resistance and treatment failure. Thus, a number of strategies have been developed over the years in hopes of improving treatment adherence. Few of these strategies have been assessed for their effectiveness.

To assess two common forms of medication dosing support, Jane Simoni, PhD, from the University of Washington, and her colleagues compared adherence rates among 224 people living with HIV participating in different support programs for three months: two-way pager reminders, peer support, reminders plus peer support and standard support.

The pager system provided reminders at the time a person’s medications needed to be taken. The peer support program consisted of one support group meeting per week, with one telephone call per week from a peer. Standard support—the usual approach to adherence counseling in HIV care—included visits with clinic staff to identify adherence barriers and strategies for overcoming obstacles.

Adherence was classified as being 100 percent adherent for seven days before completing a questionnaire. Adherence was also documented using special pill bottle caps, called electronic drug monitors (EDMs), which measure how often the medication containers were opened.

At the end of the three month intervention period, only those who received peer support were more likely to have 100 percent adherence, according to the collected EDM data. This included people who received peer support only, as well as those who received the combination of peer support and pager reminders. After the first three months, however, the positive effect of peer support began to fade, and by month six, those who received peer support were no more likely to be adherent than those who received standard support.

The people receiving only pager reminders were no more likely to have 100 percent adherence, either at three or six months, than those who received the standard support.

The authors conclude that future studies should assess specific barriers that each person living with HIV faces and, in turn, offer tailored support, rather than a one-size-fits-all approach.

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