Intervention Helps Improve HIV Drug Adherence

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By David Douglas

A multipronged intervention involving nurses and pharmacists led to a significant reduction in the number of missed drug doses in patients with HIV infection, according to Australian researchers.

"At the very least," such an approach leads to "a short-term positive impact on patient adherence," lead investigator Russell W. Levy told Reuters Health. "The added clinical perspectives which pharmacists and nurses bring to adherence counseling, positively augments the core aspects of treating HIV with antiretrovirals and improves the overall standard of care experienced by the patient."

Levy of The Alfred Hospital, Prahran, and colleagues note in the December issue of AIDS Patient Care and STDs, there is evidence that adherence rates below 90% are significantly associated with viral rebound and drug resistance. Adherence rates of 95% or higher are difficult to maintain, they add.

To determine whether drug compliance could be improved, the researchers studied 68 HIV-infected patients attending an outpatient clinic. The subjects received general education, followed by individual help taking into consideration their particular regimen and social circumstances.

The patients were given medication dose boxes and electronic alarms and a pager number by which they could contact the education pharmacist outside of standard clinic hours. The randomized, controlled trial allowed all of the patients to receive the intervention over a 20-week period.

In the 52 subjects who completed the trial, the number of doses missed in the previous 4 days fell from 1.9 to 1.0. Over the previous 7 days, the number fell from 3.0 to 1.8, and after 28 days, the decline was from 7.4 to 4.2 doses (p < 0.001 for all). There also was a significant improvement in scores involving medication-taking behavior.

Although the investigators failed to demonstrate a clinical effect, they conclude that "the significantly higher rates of adherence achieved through this intervention are likely to provide a consequent improvement" in patient outcomes.

An ongoing challenge, added Levy, is how to extend "this kind of adherence intervention to a larger proportion of the HIV-positive population who are either ready to commence treatment or who have already been taking antiretrovirals for some time."

01/26/05

AIDS Patient Care and STDs 2004;18:728-735.