Dutch researchers have developed a nurse-led counseling intervention that successfully increases adherence to antiretroviral (ARV) regimens among people with HIV and is also cost-effective, aidsmap reports.
Publishing their findings in The Lancet Infectious Diseases, scientists designed a nurse-led adherence intervention called AIMS—the Adherence Improving self-Management Strategy. To test its effects in as real-world a setting as possible, they designed a multicenter, randomized controlled study that included 221 people receiving HIV care at seven clinics in the Netherlands. The participants were randomized to receive AIMS or routine HIV care.
AIMS has numerous facets, including the use of visual aides to help people with HIV conceptualize optimal ARV levels and related adherence patterns, complete with interactive data derived from a mechanical pill box that monitors actual adherence. Nurses work one-on-one with people with HIV to help motivate them to adhere well.
People were eligible for the study if they were beginning HIV treatment for the first time or if they had been on ARVs for nine months or more and had experienced at least one recent detectable viral load test result (known as a viral breakthrough). The participant population was about evenly divided between these two categories, and a third of those who were already on treatment had a detectable viral load upon entering the study.
The researchers looked at the viral load of participants a respective 5, 10 and 15 months into their participation in the study. At these three points, those who received routine care had a viral load an average of 26 percent higher than those who received AIMS (an average viral load of 44.5 versus 35.4).
A respective 9 percent and 23 percent of those who received AIMS and routine care experienced virological failure, or two consecutive detectable viral load test results. This meant that receiving routine care, compared with receiving the adherence intervention, raised the odds of virological failure by 2.99-fold (or that AIMS lowered this risk by two thirds).
The researchers determined that AIMS was cost-effective, reducing lifetime treatment costs for people with HIV by an estimated 592 Euros (about $645). The intervention also led to a slight uptick in what are known as quality-adjusted life-years (QALYS), which is a composite measure of expected longevity and quality of life according to personal health.
To read the aidsmap article, click here.
To read the study abstract, click here.