A Preliminary Randomized Controlled Trial of a Nurse-Delivered Medication Adherence Intervention Among HIV-Positive Outpatients Initiating Antiretroviral Therapy in Beijing, China

We evaluated a nurse-delivered adherence intervention in a preliminary randomized controlled trial among 70 HIV-positive outpatients initiating antiretroviral therapy (ART) in Beijing, China. In both arms, participants received a 30-min educational session, a pillbox, and a referral to a peer support group. In the enhanced arm, participants could choose an electronic reminder device, three sessions of counseling either alone or with a treatment adherence partner, or both reminder and counseling. Survey assessments and blood draws occurred at baseline, post-intervention (13 weeks), and follow-up (25 weeks). Primary outcomes were 7-day and 30-day adherence assessed by self-report and electronic drug monitoring (EDM), and secondary outcomes were HIV-1 RNA viral load and CD4 count. The intervention was feasible and well received. It led to some improvement in self-reported and EDM-assessed adherence but not the biological outcomes. Providing counseling and facilitating the use of electronic reminders to patients initiating ART merits further investigation as a culturally viable means of promoting adherence in China.

[1]  P. Chiliade,et al.  Predictors of virologic failure in HIV-1-infected adults receiving first-line antiretroviral therapy in 8 provinces in China. , 2010, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[2]  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.

[3]  Zunyou Wu,et al.  Factors associated with adherence to antiretroviral therapy among HIV/AIDS patients in rural China , 2007, AIDS.

[4]  Zunyou Wu,et al.  The HIV/AIDS epidemic in China: history, current strategies and future challenges. , 2004, AIDS education and prevention : official publication of the International Society for AIDS Education.

[5]  G. Guyatt,et al.  Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. , 2006, JAMA.

[6]  L. Metsch,et al.  Factors Associated With Antiretroviral Therapy Adherence and Medication Errors Among HIV-Infected Injection Drug Users , 2007, Journal of acquired immune deficiency syndromes.

[7]  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.

[8]  I. Wilson,et al.  Using Electronic Drug Monitor Feedback to Improve Adherence to Antiretroviral Therapy Among HIV-Positive Patients in China , 2009, AIDS and Behavior.

[9]  C. Pearson,et al.  Conceptualizing antiretroviral adherence in Beijing, China , 2008, AIDS care.

[10]  M. Mimiaga,et al.  A survey of MSM HIV prevention outreach workers in Chennai, India. , 2006, AIDS education and prevention : official publication of the International Society for AIDS Education.

[11]  Yu Wang,et al.  Evolution of China's response to HIV/AIDS , 2007, The Lancet.

[12]  A. Agresti.  [A Survey of Exact Inference for Contingency Tables]: Rejoinder , 1992 .

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

[14]  Jennifer Pan,et al.  Current progress of China's free ART program , 2005, Cell Research.

[15]  M. Otto,et al.  Life-steps: Applying cognitive behavioral therapy to HIV medication adherence , 1999 .

[16]  Ray Y. Chen,et al.  Five-Year Outcomes of the China National Free Antiretroviral Treatment Program , 2009, Annals of Internal Medicine.

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

[18]  C. Bova,et al.  Home Visits to Improve Adherence to Highly Active Antiretroviral Therapy: A Randomized Controlled Trial , 2006, Journal of acquired immune deficiency syndromes.

[19]  A Agresti,et al.  Modelling patterns of agreement and disagreement , 1992, Statistical methods in medical research.

[20]  I. Wilson,et al.  Barriers to adherence to antiretroviral medications among patients living with HIV in southern China: a qualitative study , 2008, AIDS care.

[21]  J. Côté,et al.  Development of a nursing intervention to facilitate optimal antiretroviral-treatment taking among people living with HIV , 2009, BMC health services research.

[22]  David Huh,et al.  Peer Support and Pager Messaging to Promote Antiretroviral Modifying Therapy in Seattle: A Randomized Controlled Trial , 2009, Journal of acquired immune deficiency syndromes.

[23]  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.

[24]  Zunyou Wu,et al.  Disclosure of HIV status is a family matter: field notes from China. , 2007, Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association.

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

[26]  K. Fennie,et al.  Self-Reported adherence to antiretroviral treatment among HIV-infected people in Central China. , 2008, AIDS patient care and STDs.

[27]  S. Okie,et al.  China and HIV - a window of opportunity. , 2007, The New England journal of medicine.

[28]  J. Simoni,et al.  Optimizing HIV care by expanding the nursing role: patient and provider perspectives. , 2010, Journal of advanced nursing.

[29]  Gerjo Kok,et al.  Standard care quality determines treatment outcomes in control groups of HAART-adherence intervention studies: implications for the interpretation and comparison of intervention effects. , 2009, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[30]  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.

[31]  P. Cook,et al.  Telephone Nurse Counseling Improves HIV Medication Adherence: An Effectiveness Study , 2009, The Journal of the Association of Nurses in AIDS Care : JANAC.

[32]  C. Pearson,et al.  Chinese HIV‐Positive Patients and Their Healthcare Providers: Contrasting Confucian Versus Western Notions of Secrecy and Support , 2007, ANS. Advances in nursing science.

[33]  I. Wilson,et al.  Importance of Dose Timing to Achieving Undetectable Viral Loads , 2010, AIDS and Behavior.

[34]  N. Breslow,et al.  Regression analysis of correlated binary data : some small sample results for the estimating equation approach , 1992 .