Improving Antiretroviral Medication Adherence and Treatment Outcomes: A Randomized Controlled Trial

2.50
Hdl Handle:
http://hdl.handle.net/10755/158539
Type:
Presentation
Title:
Improving Antiretroviral Medication Adherence and Treatment Outcomes: A Randomized Controlled Trial
Abstract:
Improving Antiretroviral Medication Adherence and Treatment Outcomes: A Randomized Controlled Trial
Conference Sponsor:Midwest Nursing Research Society
Conference Year:2007
Author:Reynolds, Nancy, PhD, RN, C-NP, FAAN
P.I. Institution Name:Ohio State University
Contact Address:, Columbus, OH, 43210, USA
Co-Authors:A.A. Alonzo, Sociology, Ohio State University, Columbus, OH and H.N. Nagaraja, Statistics, Ohio State University, Columbus, OH
Background: Successful antiretroviral therapy (ART) is dependent upon adherence to prescribed medication regimens. There is little evidence supporting specific approaches for improving adherence to ART. This study examined whether an intervention driven by self-regulation theory and delivered by telephone improved adherence outcomes of persons beginning ART. Methods: The 2-arm RCT was conducted with a diverse sample of rural and urban Ohio and Illinois ADAP participants initiating or changing their ART regimen. Participants were randomly assigned to receive standard care or standard care plus 14 structured intervention calls. The calls, delivered over the first 32 weeks of ART by a nurse at a central site, were tailored and structured to proactively address common barriers to ART adherence. Outcome measures were collected at baseline, 12, 24, 36 and 52 weeks and included electronic and self-report measures of adherence and clinical endpoints (virologic, immunologic, time to regimen failure). Data were analyzed using repeated measures analysis of variance, logistic regression, and intent to treat. Results: 124 persons were randomized; 82% completed the 52 week study. Baseline characteristics (86% male, 50% AA, mean CD4 313) were similar across both groups. A significantly better overall treatment effect was observed in the telephone group (p <.05). A treatment by ART experience interaction effect was found (p<.01); persons without prior ART experience had a better treatment response. The treatment effect dissipated over time and no significant differences in adherence were observed at Week 52 (12 weeks following termination of intervention delivery), yet the treatment group had significantly better virologic outcomes (p<.05). Conclusions: An intervention guided by self-regulation theory and delivered by nurses by telephone improved adherence behavior and clinical outcomes relative to usual care especially among subjects naive to ART at baseline. The treatment effect waned with less frequent intervention calls. The inclusion of booster sessions may enhance long-term adherence. The intervention is acceptable and practical and appears to have good potential. Supported by NIH, NINR (R01 NR05108)
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Midwest Nursing Research Society

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleImproving Antiretroviral Medication Adherence and Treatment Outcomes: A Randomized Controlled Trialen_GB
dc.identifier.urihttp://hdl.handle.net/10755/158539-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Improving Antiretroviral Medication Adherence and Treatment Outcomes: A Randomized Controlled Trial</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Midwest Nursing Research Society</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Reynolds, Nancy, PhD, RN, C-NP, FAAN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Ohio State University</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">, Columbus, OH, 43210, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">reynolds.1@osu.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">A.A. Alonzo, Sociology, Ohio State University, Columbus, OH and H.N. Nagaraja, Statistics, Ohio State University, Columbus, OH</td></tr><tr><td colspan="2" class="item-abstract">Background: Successful antiretroviral therapy (ART) is dependent upon adherence to prescribed medication regimens. There is little evidence supporting specific approaches for improving adherence to ART. This study examined whether an intervention driven by self-regulation theory and delivered by telephone improved adherence outcomes of persons beginning ART. Methods: The 2-arm RCT was conducted with a diverse sample of rural and urban Ohio and Illinois ADAP participants initiating or changing their ART regimen. Participants were randomly assigned to receive standard care or standard care plus 14 structured intervention calls. The calls, delivered over the first 32 weeks of ART by a nurse at a central site, were tailored and structured to proactively address common barriers to ART adherence. Outcome measures were collected at baseline, 12, 24, 36 and 52 weeks and included electronic and self-report measures of adherence and clinical endpoints (virologic, immunologic, time to regimen failure). Data were analyzed using repeated measures analysis of variance, logistic regression, and intent to treat. Results: 124 persons were randomized; 82% completed the 52 week study. Baseline characteristics (86% male, 50% AA, mean CD4 313) were similar across both groups. A significantly better overall treatment effect was observed in the telephone group (p &lt;.05). A treatment by ART experience interaction effect was found (p&lt;.01); persons without prior ART experience had a better treatment response. The treatment effect dissipated over time and no significant differences in adherence were observed at Week 52 (12 weeks following termination of intervention delivery), yet the treatment group had significantly better virologic outcomes (p&lt;.05). Conclusions: An intervention guided by self-regulation theory and delivered by nurses by telephone improved adherence behavior and clinical outcomes relative to usual care especially among subjects naive to ART at baseline. The treatment effect waned with less frequent intervention calls. The inclusion of booster sessions may enhance long-term adherence. The intervention is acceptable and practical and appears to have good potential. Supported by NIH, NINR (R01 NR05108)</td></tr></table>en_GB
dc.date.available2011-10-26T21:09:24Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T21:09:24Z-
dc.description.sponsorshipMidwest Nursing Research Societyen_GB
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