Electronic monitoring-based counseling to enhance adherence among HIV-infected patients

a randomized controlled trial

Marijn de Bruin, Harm J. Hospers, Gerard J. P. van Breukelen, Gerjo Kok, William M. Koevoets, Jan M. Prins

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Objective: To investigated the effectiveness of an adherence intervention (AIMS) designed to fit HIV-clinics' routine care procedures. Design: Through block randomization, patients were allocated to the intervention or control group. The study included 2 months baseline measurement, 3 months intervention, and 4 months follow-up. HIV-nurses delivered a minimal intervention (“adherence sustaining”) to patients scoring >95% adherence at baseline, and an intensive intervention (“adherence improving”) to patients with <95% adherence. Control participants received high-quality usual care. Main Outcome Measures: Electronically monitored adherence and viral load. Results: 133 patients were included (67 control, 66 intervention), 60% had <95% adherence at baseline, and 87% (116/133) completed the trial. Intent-to-treat analyses showed that adherence improved significantly in the complete intervention sample. Subgroup analyses showed that this effect was caused by participants scoring <95% at baseline (mean difference = 15.20%; p < .001). These effects remained stable during follow-up. The number of patients with an undetectable viral load increased in the intervention group compared to the control group (OR = 2.96, p < .05). Treatments effects on viral load were mediated by the improvements in adherence. Conclusions: The AIMS-intervention was effective and can be integrated in routine clinical care for HIV-infected patients. Future research should study its (cost)effectiveness among more heterogeneous samples and in settings with variable levels of standard care. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Original languageEnglish
Pages (from-to)421-428
Number of pages8
JournalHealth Psychology
Volume29
Issue number4
DOIs
Publication statusPublished - Jul 2010

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Counseling
Randomized Controlled Trials
HIV
Viral Load
Control Groups
Quality of Health Care
Standard of Care
Random Allocation
Cost-Benefit Analysis
Nurses
Outcome Assessment (Health Care)
Therapeutics

Keywords

  • adult
  • aged
  • anti-retroviral agents
  • counseling
  • drug monitoring
  • drug packaging
  • female
  • follow-up studies
  • HIV infections
  • humans
  • male
  • middle aged
  • Netherlands
  • patient compliance
  • program evaluation
  • questionnaires
  • treatment outcome
  • viral load
  • young adult

Cite this

Electronic monitoring-based counseling to enhance adherence among HIV-infected patients : a randomized controlled trial. / de Bruin, Marijn; Hospers, Harm J.; van Breukelen, Gerard J. P.; Kok, Gerjo; Koevoets, William M.; Prins, Jan M.

In: Health Psychology, Vol. 29, No. 4, 07.2010, p. 421-428.

Research output: Contribution to journalArticle

de Bruin, Marijn ; Hospers, Harm J. ; van Breukelen, Gerard J. P. ; Kok, Gerjo ; Koevoets, William M. ; Prins, Jan M. / Electronic monitoring-based counseling to enhance adherence among HIV-infected patients : a randomized controlled trial. In: Health Psychology. 2010 ; Vol. 29, No. 4. pp. 421-428.
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abstract = "Objective: To investigated the effectiveness of an adherence intervention (AIMS) designed to fit HIV-clinics' routine care procedures. Design: Through block randomization, patients were allocated to the intervention or control group. The study included 2 months baseline measurement, 3 months intervention, and 4 months follow-up. HIV-nurses delivered a minimal intervention (“adherence sustaining”) to patients scoring >95{\%} adherence at baseline, and an intensive intervention (“adherence improving”) to patients with <95{\%} adherence. Control participants received high-quality usual care. Main Outcome Measures: Electronically monitored adherence and viral load. Results: 133 patients were included (67 control, 66 intervention), 60{\%} had <95{\%} adherence at baseline, and 87{\%} (116/133) completed the trial. Intent-to-treat analyses showed that adherence improved significantly in the complete intervention sample. Subgroup analyses showed that this effect was caused by participants scoring <95{\%} at baseline (mean difference = 15.20{\%}; p < .001). These effects remained stable during follow-up. The number of patients with an undetectable viral load increased in the intervention group compared to the control group (OR = 2.96, p < .05). Treatments effects on viral load were mediated by the improvements in adherence. Conclusions: The AIMS-intervention was effective and can be integrated in routine clinical care for HIV-infected patients. Future research should study its (cost)effectiveness among more heterogeneous samples and in settings with variable levels of standard care. (PsycINFO Database Record (c) 2012 APA, all rights reserved)",
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AU - de Bruin, Marijn

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AU - van Breukelen, Gerard J. P.

AU - Kok, Gerjo

AU - Koevoets, William M.

AU - Prins, Jan M.

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N2 - Objective: To investigated the effectiveness of an adherence intervention (AIMS) designed to fit HIV-clinics' routine care procedures. Design: Through block randomization, patients were allocated to the intervention or control group. The study included 2 months baseline measurement, 3 months intervention, and 4 months follow-up. HIV-nurses delivered a minimal intervention (“adherence sustaining”) to patients scoring >95% adherence at baseline, and an intensive intervention (“adherence improving”) to patients with <95% adherence. Control participants received high-quality usual care. Main Outcome Measures: Electronically monitored adherence and viral load. Results: 133 patients were included (67 control, 66 intervention), 60% had <95% adherence at baseline, and 87% (116/133) completed the trial. Intent-to-treat analyses showed that adherence improved significantly in the complete intervention sample. Subgroup analyses showed that this effect was caused by participants scoring <95% at baseline (mean difference = 15.20%; p < .001). These effects remained stable during follow-up. The number of patients with an undetectable viral load increased in the intervention group compared to the control group (OR = 2.96, p < .05). Treatments effects on viral load were mediated by the improvements in adherence. Conclusions: The AIMS-intervention was effective and can be integrated in routine clinical care for HIV-infected patients. Future research should study its (cost)effectiveness among more heterogeneous samples and in settings with variable levels of standard care. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

AB - Objective: To investigated the effectiveness of an adherence intervention (AIMS) designed to fit HIV-clinics' routine care procedures. Design: Through block randomization, patients were allocated to the intervention or control group. The study included 2 months baseline measurement, 3 months intervention, and 4 months follow-up. HIV-nurses delivered a minimal intervention (“adherence sustaining”) to patients scoring >95% adherence at baseline, and an intensive intervention (“adherence improving”) to patients with <95% adherence. Control participants received high-quality usual care. Main Outcome Measures: Electronically monitored adherence and viral load. Results: 133 patients were included (67 control, 66 intervention), 60% had <95% adherence at baseline, and 87% (116/133) completed the trial. Intent-to-treat analyses showed that adherence improved significantly in the complete intervention sample. Subgroup analyses showed that this effect was caused by participants scoring <95% at baseline (mean difference = 15.20%; p < .001). These effects remained stable during follow-up. The number of patients with an undetectable viral load increased in the intervention group compared to the control group (OR = 2.96, p < .05). Treatments effects on viral load were mediated by the improvements in adherence. Conclusions: The AIMS-intervention was effective and can be integrated in routine clinical care for HIV-infected patients. Future research should study its (cost)effectiveness among more heterogeneous samples and in settings with variable levels of standard care. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

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