Using electronic drug monitor feedback to improve adherence to antiretroviral therapy among HIV-positive patients in China

Lora L Sabin, Mary Bachman DeSilva, Davidson H Hamer, Keyi Xu, Jianbo Zhang, Tao Li, Ira B Wilson, Christopher J Gill, Lora L Sabin, Mary Bachman DeSilva, Davidson H Hamer, Keyi Xu, Jianbo Zhang, Tao Li, Ira B Wilson, Christopher J Gill

Abstract

Effective antiretroviral therapy (ART) requires excellent adherence. Little is known about how to improve ART adherence in many HIV/AIDS-affected countries, including China. We therefore assessed an adherence intervention among HIV-positive patients in southwestern China. Eighty subjects were enrolled and monitored for 6 months. Sixty-eight remaining subjects were randomized to intervention/control arms. In months 7-12, intervention subjects were counseled using EDM feedback; controls continued with standard of care. Among randomized subjects, mean adherence and CD4 count were 86.8 vs. 83.8% and 297 vs. 357 cells/microl in intervention vs. control subjects, respectively. At month 12, among 64 subjects who completed the trial, mean adherence had risen significantly among intervention subjects to 96.5% but remained unchanged in controls. Mean CD4 count rose by 90 cells/microl and declined by 9 cells/microl among intervention and control subjects, respectively. EDM feedback as a counseling tool appears promising for management of HIV and other chronic diseases.

Figures

Fig. 1
Fig. 1
Study profile. The study involved 12 months of data collection for each subject; with rolling admission from June to November 2006, Months 1–6 of data collection took place from June 2006 to May 2007 and Months 7–12 of data collection took place from January to November 2007
Fig. 2
Fig. 2
Monthly mean adherence among intervention and control subjects, stratified by mean adherence in pre-intervention period: high (≥95%) vs. low (

References

    1. Bangsberg DR, Hecht FM, Charlebois ED, Zolopa AR, Holodniy M, Sheiner L, Bamberger JD, Chesney MA, Moss A. Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS. 2000;14(4):357–366. doi: 10.1097/00002030-200003100-00008.
    1. Gross R, Bilker WB, Friedman HM, Strom BL. Effect of adherence to newly initiated antiretroviral therapy on plasma viral load. AIDS. 2001;15(16):2109–2117. doi: 10.1097/00002030-200111090-00006.
    1. Hogg RS, Heath K, Bangsberg D, Yip B, Press N, O’Shaughnessy MV, Montaner JS. Intermittent use of triple-combination therapy is predictive of mortality at baseline and after 1 year of follow-up. AIDS. 2002;16(7):1051–1058. doi: 10.1097/00002030-200205030-00012.
    1. Paterson DL, Swindells S, Mohr J, Brester M, Vergis EN, Squier C, Wagener MM, Singh N. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133(1):21–30.
    1. Bangsberg DR. Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clin Infect Dis. 2006;43(7):939–941. doi: 10.1086/507526.
    1. Palombi L, Marazzi MC, Guidotti G, Germano P, Buonomo E, Scarcella P, Doro Altan A, Da Vitoria MZI, Magnano San Lio M, De Luca A. Incidence and predictors of death, retention, and switch to second-line regimens in antiretroviral-treated patients in Sub-Saharan African sites with comprehensive monitoring availability. Clin Infect Dis. 2008;48:115–122. doi: 10.1086/593312.
    1. Simoni JM, Pearson CR, Pantalone DW, Marks G, Crepaz N. Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load. A meta-analytic review of randomized controlled trials. J Acquir Immune Defic Syndr. 2006;43(Suppl 1):S23–S35.
    1. Detels R, Tarwater P, Phair JP, Margolick J, Riddler SA, Munoz A. Effectiveness of potent antiretroviral therapies on the incidence of opportunistic infections before and after AIDS diagnosis. AIDS. 2001;15(3):347–355. doi: 10.1097/00002030-200102160-00008.
    1. Keiser P, Nassar N, Kvanli MB, Turner D, Smith JW, Skiest D. Long-term impact of highly active antiretroviral therapy on HIV-related health care costs. J Acquir Immune Defic Syndr. 2001;27(1):14–19.
    1. Sendi PP, Bucher HC, Harr T, Craig BA, Schwietert M, Pfluger D, Gafni A, Battegay M. Cost effectiveness of highly active antiretroviral therapy in HIV-infected patients. Swiss HIV cohort study. AIDS. 1999;13(9):1115–1122. doi: 10.1097/00002030-199906180-00016.
    1. Valenti WM. Treatment adherence improves outcomes and manages costs. AIDS Read. 2001;11(2):77–80.
    1. Kozal MJ, Hullsiek KH, Macarthur RD, Berg-Wolf M, Peng G, Xiang Y, Baxter JD, Uy J, Telzak EE, Novak RM. The incidence of HIV drug resistance and its impact on progression of HIV disease among antiretroviral-naive participants started on three different antiretroviral therapy strategies. HIV Clin Trials. 2007;8(6):357–370. doi: 10.1310/hct0806-357.
    1. Hogg RS, Bangsberg DR, Lima VD, Alexander C, Bonner S, Yip B, Wood E, Dong WW, Montaner JS, Harrigan PR. Emergence of drug resistance is associated with an increased risk of death among patients first starting HAART. PLoS Med. 2006;3(9):e356. doi: 10.1371/journal.pmed.0030356.
    1. Colson P, Ravaux I, Yahi N, Tourres C, Gallais H, Tamalet C. Transmission of HIV-1 variants resistant to the three classes of antiretroviral agents: implications for HIV therapy in primary infection. AIDS. 2002;16(3):507–509. doi: 10.1097/00002030-200202150-00034.
    1. Siegrist CA, Yerly S, Kaiser L, Wyler CA, Perrin L. Mother to child transmission of zidovudine-resistant HIV-1. Lancet. 1994;344(8939–8940):1771–1772. doi: 10.1016/S0140-6736(94)92911-4.
    1. Amico KR, Harman JJ, Johnson BT. Efficacy of antiretroviral therapy adherence interventions: a research synthesis of trials, 1996 to 2004. J Acquir Immune Defic Syndr. 2006;41(3):285–297. doi: 10.1097/01.qai.0000197870.99196.ea.
    1. DiIorio C, Resnicow K, McDonnell M, Soet J, McCarty F, Yeager K. Using motivational interviewing to promote adherence to antiretroviral medications: a pilot study. J Assoc Nurses AIDS Care. 2003;14(2):52–62. doi: 10.1177/1055329002250996.
    1. Goujard C, Bernard N, Sohier N, Peyramond D, Lancon F, Chwalow J, Arnould B, Delfraissy JF. Impact of a patient education program on adherence to HIV medication: a randomized clinical trial. J Acquir Immune Defic Syndr. 2003;34(2):191–194. doi: 10.1097/00126334-200310010-00009.
    1. Parsons JT, Golub SA, Rosof E, Holder C. Motivational interviewing and cognitive-behavioral intervention to improve HIV medication adherence among hazardous drinkers: a randomized controlled trial. J Acquir Immune Defic Syndr. 2007;46(4):443–450. doi: 10.1097/QAI.0b013e318158a461.
    1. Safren SA, Otto MW, Worth JL, Salomon E, Johnson W, Mayer K, Boswell S. Two strategies to increase adherence to HIV antiretroviral medication: life-steps and medication monitoring. Behav Res Ther. 2001;39(10):1151–1162. doi: 10.1016/S0005-7967(00)00091-7.
    1. Bangsberg DR. Monitoring adherence to HIV antiretroviral therapy in routine clinical practice: the past, the present, and the future. AIDS Behav. 2006;10(3):249–251. doi: 10.1007/s10461-006-9121-7.
    1. Bangsberg DR. Preventing HIV antiretroviral resistance through better monitoring of treatment adherence. J Infect Dis. 2008;197(Suppl 3):S272–S278. doi: 10.1086/533415.
    1. Arnsten JH, Demas PA, Farzadegan H, Grant RW, Gourevitch MN, Chang CJ, Buono D, Eckholdt H, Howard AA, Schoenbaum EE. Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring. Clin Infect Dis. 2001;33(8):1417–1423. doi: 10.1086/323201.
    1. Smith SR, Rublein JC, Marcus C, Brock TP, Chesney MA. A medication self-management program to improve adherence to HIV therapy regimens. Patient Educ Couns. 2003;50(2):187–199.
    1. Rosen MI, Dieckhaus K, McMahon TJ, Valdes B, Petry NM, Cramer J, Rounsaville B. Improved adherence with contingency management. AIDS Patient Care STDS. 2007;21(1):30–40. doi: 10.1089/apc.2006.0028.
    1. World Health Organization . The world health report—working together for health. Geneva: World Health Organization; 2006.
    1. State Council AIDS Working Committee Office & UN Theme Group on AIDS in China. A joint assessment of HIV/AIDS prevention, treatment and care in China (2007). Beijing: December 1, 2007.
    1. UNAIDS. Report on the global AIDS epidemic 08. Mexico City: Joint United Nations Programme on HIV/AIDS; August 2008.
    1. Wu Z, Rou K, Detels R. Prevalence of HIV infection among former commercial plasma donors in rural eastern China. Health Policy Plan. 2001;16(1):41–46. doi: 10.1093/heapol/16.1.41.
    1. Ministry of Health of China. UNAIDS. WHO . 2005 update on the HIV/AIDS epidemic and response in China. Beijing: Ministry of Health; 2006.
    1. Yan J, Zheng X, Zhang X, et al. The survey of prevalence of HIV infection among paid blood donors in one county in China. Zhonghua Liu Xing Bing Xue Za Zhi [Chinese Journal of Infectious Diseases] 2000;21(1):10–13.
    1. He N, Detels R. The HIV epidemic in China: history, response, and challenge. Cell Res. 2005;15(11–12):825–832. doi: 10.1038/sj.cr.7290354.
    1. Wu Z, Sullivan SG, Wang Y, Rotheram-Borus MJ, Detels R. Evolution of China’s response to HIV/AIDS. Lancet. 2007;369(9562):679–690. doi: 10.1016/S0140-6736(07)60315-8.
    1. Zhang F, Hsu M, Yu L, Wen Y, Two J, Zhang R. Initiation of the national ARV therapy program in rural China. Beijing: July 2004.
    1. Zhang F, Hsu M, Yu L, Wen Y, Pan J. Initiation of the national free antiretroviral therapy program in rural China. In: Kaufman J, Kleinman A, Saich T, editors. AIDS and social policy in China. Cambridge, MA: Harvard University Asia Center; 2006. pp. 96–104.
    1. Starks H, Simoni J, Zhao H, Huang B, Fredriksen-Goldsen K, Pearson C, Chen WT, Lu L, Zhang F. Conceptualizing antiretroviral adherence in Beijing, China. AIDS Care. 2008;20(6):607–614. doi: 10.1080/09540120701660379.
    1. Sabin LL, Desilva MB, Hamer DH, Keyi X, Yue Y, Wen F, Tao L, Heggenhougen HK, Seton L, Wilson IB, Gill CJ. Barriers to adherence to antiretroviral medications among patients living with HIV in southern China: a qualitative study. AIDS Care. 2008;20(10):1242–1250. doi: 10.1080/09540120801918651.
    1. Wang H, He G, Li X, Yang A, Chen X, Fennie KP, Williams AB. Self-reported adherence to antiretroviral treatment among HIV-infected people in Central China. AIDS Patient Care STDS. 2008;22(1):71–80. doi: 10.1089/apc.2007.0047.
    1. Fisher JD, Fisher WA, Amico KR, Harman JJ. An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol. 2006;25(4):462–473. doi: 10.1037/0278-6133.25.4.462.
    1. Gill CJ, Sabin LL, Hamer DH, Xu K, Zhang J, Li T, Wu W-J, Wilson IB, Bachman DeSilva M. Importance of dose timing to achieving undetectable viral loads. AIDS Behav. 2009; Published online: April 8, 2009.
    1. Xiao Y, Kristensen S, Sun J, Lu L, Vermund SH. Expansion of HIV/AIDS in China: lessons from Yunnan Province. Soc Sci Med. 2007;64(3):665–675. doi: 10.1016/j.socscimed.2006.09.019.
    1. Remien RH, Stirratt MJ, Dolezal C, Dognin JS, Wagner GJ, Carballo-Dieguez A, El-Bassel N, Jung TM. Couple-focused support to improve HIV medication adherence: a randomized controlled trial. AIDS. 2005;19(8):807–814. doi: 10.1097/01.aids.0000168975.44219.45.
    1. Margolin A, Avants SK, Warburton LA, Hawkins KA, Shi J. A randomized clinical trial of a manual-guided risk reduction intervention for HIV-positive injection drug users. Health Psychol. 2003;22(2):223–228. doi: 10.1037/0278-6133.22.2.223.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren