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Impact of an Adherence Program on the Health and Outlook of HIV-Infected Patients Failing Antiretroviral Therapy

Division of Infectious Diseases, Department of Medicine, and the Clinical Effectiveness Program, The Stamford Hospital, Stamford, Connecticut, Division of Infectious Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York

Pamela Wright, BSN

Division of Infectious Diseases, Department of Medicine, and the Clinical Effectiveness Program, The Stamford Hospital, Stamford, Connecticut

Julie Stewart, MS, MPH

Division of Infectious Diseases, Department of Medicine, and the Clinical Effectiveness Program, The Stamford Hospital, Stamford, Connecticut

Gavin X. McLeod, MD

Division of Infectious Diseases, Department of Medicine, and the Clinical Effectiveness Program, The Stamford Hospital, Stamford, Connecticut, Division of Infectious Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York

James Tucker, MBA

Division of Infectious Diseases, Department of Medicine, and the Clinical Effectiveness Program, The Stamford Hospital, Stamford, Connecticut

Amy R. Weinberg, MS

Division of Infectious Diseases, Department of Medicine, and the Clinical Effectiveness Program, The Stamford Hospital, Stamford, Connecticut, aweinberg{at}stamhealth.org

Background: We prospectively studied the impact of an adherence counselor on the outcome of patients failing antiretroviral therapy because of nonadherence. Methods: Forty-six patients, identified as chronically nonadherent were enrolled. Individual attention was provided using the information, motivation and behavioral methodology. HIV RNA (viral load, in copies/mL), CD4 count (in cells/mm³), and body weight before and after the adherence counselor were measured. Qualitative outcome and patient satisfaction were assessed by deidentified third-party interviews. Results: Over half completed at least 1 year; only 8 patients were lost to follow-up. Mean CD4 counts increased significantly (P < .05) for completers at 6 and 12 months. Viral loads decreased between baseline and 6 months. Most clients reported subjective benefit from working with the adherence counselor. Conclusion: Although few clients showed complete virologic suppression, the value of an adherence counselor was validated. Longer term adherence programs should be evaluated.

Key Words: adherence • failure of medical management • compliance • counseling • HIV outcomes

Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 4, No. 3, 59-65 (2005)
DOI: 10.1177/1545109705281897


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