Program Schedule

539
Peer-led intervention to address non-adherence among adults linked to HIV medical care but failing treatment

Session: Oral Abstract Session: HIV Antiretroviral Therapy
Thursday, October 9, 2014: 2:45 PM
Room: The Pennsylvania Convention Center: 107-AB

Background:

HIV testing and linkage initiatives are identifying undiagnosed cases and establishing medical care for these individuals. However, non-adherence to antiretroviral (ART) treatment remains a prevalent, vexing problem even among the 'linked' segment of the U.S. HIV population.

Methods:

A feasibility study with ART experienced adult patients (n=20) linked to HIV medical care but failing treatment. Patients from one safety-net urban clinic were randomized to a theory-driven, peer-led HIV medication adherence intervention named 'Ready' designed to enhance readiness for the healthful behavior change of adherence or to a time equivalent 'healthy eating' control arm. Lay individuals living with HIV were trained to facilitate 'Ready', which consisted of six weekly one-hour sessions and one booster. Patients were followed for 24 weeks. Primary aims were feasibility of the peer-led intervention and impact on adherence (measured by HIV PCR, MEMS and pharmacy refills). Mediator (readiness for healthful behavior change) and moderator (depression and social support) analyses were done.

Results:

Patients had failed a mean of three prior ART regimens due to non-adherence. Only those randomized to 'Ready' had significantly improved adherence. MEMS and pharmacy refill data correlated with viral load log drop. Higher readiness for healthful behavior change, particularly re-evaluation of lifestyle, correlated with viral load drop and approached significance (0.09). No significant changes were observed in depression or social support.

Conclusion:

The peer-led 'Ready' medication adherence intervention was feasible, enhanced readiness for healthful behavior change and had a positive impact on adherence among adults who had repeatedly failed HIV treatment due to non-adherence. A larger multi-center study with longer follow-up is needed to examine ease of intervention dissemination and efficacy.

HIV RNA PCR log drop: baseline to 12 & 24 wks post-intervention

'Ready' group

M (SD) (n=10)

'Healthy Eating'

M (SD) (n=10)

Difference

M (SD)

Test statistics

P

12 wk log drop

2.6180(0.8113)

0.7036(1.1492)

1.9144(0.9947)

-4.30

0.0004

24 wk log drop

3.3439(1.1101)

0.6143(1.8760)

2.7295(1.5414)

-3.96

0.0009

          

David Mckinsey, MD, Medicine, Infectious Disease Associates, Kansas City, MO, Maithe Enriquez, PhD, Nursing, University of Missouri, Columbia, MO and An-Lin Cheng, PhD, Nursing, University of Missouri-Kansas City, Kansas City, MO

Disclosures:

D. Mckinsey, None

M. Enriquez, None

A. L. Cheng, None

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