An empirical test of the Information, Motivation and Behavioral Skills model of antiretroviral therapy adherence

Abstract Nearly perfect adherence to demanding antiretroviral therapy (ART) is now recognized as essential for HIV-positive patients to realize its life sustaining benefits. Despite the dire consequences of non-adherence, a large number of patients do not follow their ART regimen. While many factors influence adherence, the literature is dominated by studies on only one or a small set of them. Multivariate, theory-based models of adherence behavior are of great interest. The current study tested one such model, the Information, Motivation and Behavioral Skills (IMB) model of ART adherence (Fisher et al., under review ). A sample of HIV-positive patients on ART in clinical care in Puerto Rico (N=200) provided data on adherence-related information, motivation and behavioral skills as well as adherence behavior per se. Structural equation model tests used to assess the propositions of the IMB model of ART adherence provided support for the interrelations between the elements proposed by the model and extended previous work. Implications for future research and intervention development are discussed.

[1]  A. Wu,et al.  Patient‐Reported Nonadherence to HAART Is Related to Protease Inhibitor Levels , 2000, Journal of acquired immune deficiency syndromes.

[2]  Issues Regarding Antiretroviral Treatment for Patients With HIV-1 Infection , 1997 .

[3]  R. Hogg,et al.  Adherence to triple therapy and viral load response. , 2000, Journal of acquired immune deficiency syndromes.

[4]  S. Misovich A measure of AIDS prevention Information, Motivation, Behavioral Skills, and Behavior , 1998 .

[5]  D. Bangsberg,et al.  Paradoxes of adherence and drug resistance to HIV antiretroviral therapy. , 2004, The Journal of antimicrobial chemotherapy.

[6]  J. Casado,et al.  Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study , 2002, AIDS.

[7]  S. Swindells,et al.  Adherence of human immunodeficiency virus-infected patients to antiretroviral therapy. , 1999, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[8]  Elizabeth Connick,et al.  Antiretroviral-drug resistance among patients recently infected with HIV. , 2002, The New England journal of medicine.

[9]  K. Teo,et al.  Psychosocial components of cardiac recovery and rehabilitation attendance , 2001, Heart.

[10]  D Johnson,et al.  The value of patient-reported adherence to antiretroviral therapy in predicting virologic and immunologic response. California Collaborative Treatment Group. , 1999, AIDS.

[11]  Rex B. Kline,et al.  Principles and Practice of Structural Equation Modeling , 1998 .

[12]  J. Caylà,et al.  Impact of Adherence and Highly Active Antiretroviral Therapy on Survival in HIV‐Infected Patients , 2002, Journal of acquired immune deficiency syndromes.

[13]  Roleplayed Safer Sex Skills of Heterosexual College Students Influenced by Both Personal and Partner Factors , 1998, AIDS and Behavior.

[14]  G. Luftman,et al.  Antiretroviral adherence issues among HIV-positive adolescents and young adults. , 1999, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[15]  M. Sprangers,et al.  Limited patient adherence to highly active antiretroviral therapy for HIV-1 infection in an observational cohort study. , 2001, Archives of internal medicine.

[16]  J. Fisher,et al.  A general social psychological model for changing AIDS risk behavior. , 1993 .

[17]  K Rivet Amico,et al.  An information-motivation-behavioral skills model of adherence to antiretroviral therapy. , 2006, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[18]  G. Ippolito,et al.  Factors related to virologic failure among HIV-positive injecting drug users treated with combination antiretroviral therapy including two nucleoside reverse transcriptase inhibitors and nevirapine. , 2002, AIDS patient care and STDs.

[19]  A. Bandura Self-efficacy: toward a unifying theory of behavioral change. , 1977, Psychological review.

[20]  Sundhiya Mandalia,et al.  Responses to a 1 month self-report on adherence to antiretroviral therapy are consistent with electronic data and virological treatment outcome , 2002, AIDS.

[21]  A. Macher,et al.  Issues regarding antiretroviral treatment for patients with HIV-1 infection. , 1997, JAMA.

[22]  J. Phair,et al.  Determinants of heterogeneous adherence to HIV-antiretroviral therapies in the Multicenter AIDS Cohort Study. , 2001 .

[23]  J. Cramer,et al.  Cue-dose training with monetary reinforcement: pilot study of an antiretroviral adherence intervention. , 2000, Journal of general internal medicine.

[24]  A. Burgess,et al.  Reasons for non-adherence to antiretroviral therapy: Patients' perspectives provide evidence of multiple causes , 2001, AIDS care.

[25]  D. Bangsberg,et al.  Multiple Validated Measures of Adherence Indicate High Levels of Adherence to Generic HIV Antiretroviral Therapy in a Resource-Limited Setting , 2004, Journal of acquired immune deficiency syndromes.

[26]  J. Moatti,et al.  Adherence to highly active antiretroviral therapies (HAART) in HIV-infected patients: from a predictive to a dynamic approach. , 2002, Social science & medicine.

[27]  Anne M Johnson,et al.  Effect of computer-assisted self-interviews on reporting of sexual HIV risk behaviours in a general population sample: a methodological experiment , 2001, AIDS.

[28]  R. Grant,et al.  Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[29]  Susan Swindells,et al.  Adherence to Protease Inhibitor Therapy and Outcomes in Patients with HIV Infection , 2000, Annals of Internal Medicine.

[30]  John A. Bartlett,et al.  Addressing the Challenges of Adherence , 2002, Journal of acquired immune deficiency syndromes.

[31]  J. Moatti,et al.  Impact of short-term adherence on virological and immunological success of HAART: a case study among French HIV-infected IDUs , 2001, International journal of STD & AIDS.

[32]  S. Strack,et al.  Self-efficacy, Outcome Expectancy, Dental Health Value, and Dental Plaque , 1999 .

[33]  A. Wu,et al.  Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG Adherence Instruments , 2000, AIDS care.

[34]  H. Sørensen,et al.  Low mortality in HIV-infected patients starting highly active antiretroviral therapy: a comparison with the general population , 2003, AIDS.

[35]  Y. Cao,et al.  HIV-1 drug resistance in newly infected individuals. , 1999, JAMA.

[36]  B. Roca,et al.  Adherence, side effects and efficacy of stavudine plus lamivudine plus nelfinavir in treatment-experienced HIV-infected patients. , 2000, The Journal of infection.

[37]  A. Zolopa,et al.  High levels of adherence do not prevent accumulation of HIV drug resistance mutations , 2003, AIDS.