Peer Support and Pager Messaging to Promote Antiretroviral Modifying Therapy in Seattle: A Randomized Controlled Trial

Objective:To determine the relative efficacy of peer support and pager messaging strategies versus usual care to improve medication adherence and clinical outcomes among HIV-positive outpatients initiating or switching to a new highly active antiretroviral therapy regimen. Design:A 2 × 2 factorial randomized controlled trial of a 3-month intervention with computer-assisted self-interviews and blood draws administered at baseline, 3, 6, and 9 months. Methods:HIV-positive patients at a public HIV specialty clinic in Seattle, WA (N = 224) were randomly assigned to peer support, pager messaging, both strategies, or usual care. The main outcomes were adherence according to self-report and electronic drug monitoring, CD4 count, and HIV-1 RNA viral load. Results:Intent-to-treat analyses suggested the peer intervention was associated with greater self-reported adherence at immediate postintervention. However, these effects were not maintained at follow-up assessment; nor were there significant differences in biological outcomes. The pager intervention, on the other hand, was not associated with greater adherence but was associated with improved biological outcomes at postintervention that were sustained at follow-up. Conclusions:Analyses indicate the potential efficacy of peer support and pager messaging to promote antiretroviral adherence and biological outcomes, respectively. More potent strategies still are needed.

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

[2]  Ann E. Kurth,et al.  Self-Report Measures of Antiretroviral Therapy Adherence: A Review with Recommendations for HIV Research and Clinical Management , 2006, AIDS and Behavior.

[3]  P. Grant,et al.  The effect of a multidisciplinary program on HAART adherence. , 2006, AIDS patient care and STDs.

[4]  Diane P. Martin,et al.  Randomized Control Trial of Peer-Delivered, Modified Directly Observed Therapy for HAART in Mozambique , 2007, Journal of acquired immune deficiency syndromes.

[5]  Mark R Wallace,et al.  Comparisons of Causes of Death and Mortality Rates Among HIV-Infected Persons: Analysis of the Pre-, Early, and Late HAART (Highly Active Antiretroviral Therapy) Eras , 2006, Journal of acquired immune deficiency syndromes.

[6]  M. Otto,et al.  Two strategies to increase adherence to HIV antiretroviral medication: life-steps and medication monitoring. , 2001, Behaviour research and therapy.

[7]  Gary Marks,et al.  Efficacy of Interventions in Improving Highly Active Antiretroviral Therapy Adherence and HIV-1 RNA Viral Load: A Meta-Analytic Review of Randomized Controlled Trials , 2006, Journal of acquired immune deficiency syndromes.

[8]  Blair T. Johnson,et al.  Efficacy of Antiretroviral Therapy Adherence Interventions: A Research Synthesis of Trials, 1996 to 2004 , 2006, Journal of acquired immune deficiency syndromes.

[9]  Susan Olender,et al.  Advances in antiretroviral therapy. , 2009, Topics in HIV medicine : a publication of the International AIDS Society, USA.

[10]  D. Operario,et al.  Use of electronic reminder devices to improve adherence to antiretroviral therapy: a systematic review. , 2008, AIDS patient care and STDs.

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

[12]  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.

[13]  Douglas G Altman,et al.  Analysis and reporting of factorial trials: a systematic review. , 2003, JAMA.

[14]  Milton C Weinstein,et al.  The survival benefits of AIDS treatment in the United States. , 2006, The Journal of infectious diseases.

[15]  A. Carballo-Diéguez,et al.  Couple-focused support to improve HIV medication adherence: a randomized controlled trial , 2005, AIDS.

[16]  S. Zeger,et al.  Longitudinal data analysis using generalized linear models , 1986 .

[17]  I. Buchan,et al.  Adherence to HAART : A Systematic Review of Developed and Developing Nation Patient-Reported Barriers and Facilitators , 2006 .

[18]  J. Simoni,et al.  A randomized controlled trial of a peer support intervention targeting antiretroviral medication adherence and depressive symptomatology in HIV-positive men and women. , 2007, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[19]  S. Kegeles,et al.  Social and psychological context for HIV risk in non-gay-identified African American men who have sex with men. , 2008, AIDS education and prevention : official publication of the International Society for AIDS Education.