Adherence with HIV therapy regimens remains difficult for some patients. Nurse-delivered interventions can increase adherence, reduce disease costs, and extend the lifespan in an HIV-infected population.
Although numerous advances in antiretroviral therapy have made it possible for people with HIV to live just about as long as non-infected people, adherence to HIV therapy regimens remains difficult for some patients. These lapses in treatment can result in increased viral loads, a higher attendant risk of developing AIDS, and a greater risk of transmitting the virus to others.
To this end, scientists at the University of Aberdeen in Scotland and the University of Amsterdam and Maastricht University, both in the Netherlands, recruited 221 HIV-positive patients from seven HIV clinics in Holland. The patients either had experience using HIV treatment or had never initiated treatment. They were randomly assigned to one of two groups: the Adherence Improving self-Management Strategy (AIMS) group, or the treatment-as-usual group.
In the AIMS group, participants received their HIV medication in containers with electronic caps that recorded the time and date each time the bottle was opened, as well as engaged in one-on-one counseling sessions with trained nurses who discussed the importance of adherence and helped participants meet their own stated compliance goals. Patients were offered coping strategies for difficult times as well as printed reports that displayed their adherence to their personal treatment plans. The nurses were careful to tailor each intervention to the individual patients with whom they worked. They offered praise for times when the patients adhered to their medication regimen and pointed out periods during which treatment adherence was suboptimal. The average length of an AIMS treatment session was 29.1 minutes.
Patients in the treatment-as-usual group received an explanation of how their medication worked, how and when to take it, and the link between their adherence and their viral levels. They were given a phone number to call if they had any problems. During visits with the nurse, patients discussed how well they were doing in terms of adherence and whether they had any side effects, and they learned whether their viral load and CD4 cell counts were desirable. The average length of a treatment-as-usual visit was 18.8 minutes.
When measured 5, 10, and 15 months from the beginning of the study, the patients’ viral loads were 1.26 times higher in the treatment-as-usual group than in the AIMS group. The extra steps taken in the AIMS also lowered the risk that treatment would fail by 61%; a total of 9.6% of AIMS patients experienced treatment failure vs. 22.8% percent of treatment-as-usual patients. (Treatment failure was defined as two consecutive blood tests in which viral loads were detected). The AIMS group also proved to be more cost effective, slashing projected lifetime societal costs per patient by 592 Euros (roughly $635) and increasing projected quality-adjusted life-years by .034 per patient.
As AIMS clinical visits are only about 10 minutes longer than typical clinical visits, and training for nurses and other providers can be achieved without an enormous expenditure of resources, some in the scientific community are eager to adopt AIMS as the new standard of care. Although getting patients to alter their behavior can be challenging, the team is thankful for a recent grant from ZonMw, the Netherlands Organisation for Health Research and Development, that will allow them to partner with HIV/AIDS organizations and other medical associations to implement AIMS in treatment and insurance guidelines.
“If this is successful, we would expect AIMS to improve patient health, reduce health care expenditure, and contribute to the prevention of HIV transmission,” said Marijn de Bruin, PhD, a professor and chair of the health psychology department at the College of Life Sciences and Medicine, University of Aberdeen, and an author of the study. “The results should be applicable to other conditions, since the principles of behavior change/supporting adherence are quite similar for different treatments. It would only require adapting the content of certain components, [such as] the information provided about the disease and treatment.
Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.