Personalized plans to address barriers to HIV drug adherence boost chances of successful therapy

January 29, 2013

HIV patients who participated in an intervention that helped them identify barriers to taking their drugs properly and develop customized coping strategies took a significantly greater amount of their prescribed doses than those receiving standard care, according to a new study from researchers in the Perelman School of Medicine at the University of Pennsylvania. The results, published this week in JAMA Internal Medicine, may point to a new strategy to improve adherence to medications for many other conditions.

"Nonadherence to is a silent epidemic that undercuts physicians' efforts to treat diseases from and hypertension to HIV and diabetes," says the new study's lead author, Robert Gross, MD, MSCE, an associate professor of and Epidemiology. "We tend to view the problem as either a failure on our part or on the patient's part, but the results of our new study show that we can do our jobs better by sharing the planning role with them to overcome possible stumbling blocks to taking their ."

have turned HIV/AIDS into a manageable, for many patients who would have died of the disease before the development of these medications, but they require lifelong adherence to be effective. The drugs have short half lives and need to be in the patients' system at all time in order to keep the virus from replicating, so frequently missing doses drastically cuts the chances that treatment will be successful. Predicting which patients will adhere to therapy has proven difficult.

"The barriers to taking these drugs properly are not universal – for some patients, substance abuse or depression might undercut efforts to stay on track, and for others, the complexity of the dosing regimen may pose a problem. Side effects – both real and perceived – can impact adherence, and like low or a chaotic lifestyle can interfere, too," Gross says. "We know from previous research that these issues cannot be overcome by simple education or simple technology alone, and financial incentives typically don't produce a sustained effect."

The researchers studied 180 patients receiving care at three Philadelphia HIV clinics, who were divided into two groups, one of which was randomized to a Managed Problem Solving (MAPS) group, and the other to usual care, which included a meeting with a pharmacist for drug regimen education and the provision of pill organizers. In order to study the benefit of the intervention, only patients who had detectable viral loads were enrolled.

With the help of a trained lay interventionist, MAPS participants received education about their newly prescribed drug regimen and then were taken through a process for identifying their personal barriers to adherence, brainstorming potential solutions, selecting the best option and monitoring its implementation. Potential solutions included memory and cognitive aids to remember to take and refill the drugs, ways to use social supports, and resources to seek help for depression or drug side effects. These plans were made during four initial in-person sessions and 12 telephone meetings that provided help for solving new problems and offering encouragement for obtaining refills and maintaining their regimens. Both groups' adherence to their drug regimen was recorded through the use of an electronically monitored pill bottle.

The results showed that the MAPS group was nearly twice (1.78 times) as likely as the usual care group to be at the better end of the adherence scale. Importantly, the researchers showed that this improvement in adherence translated to improvement in a key marker of survival. The MAPS group also had a 50 percent improvement in their viral suppression rate – having no detectable HIV virus in the blood while on treatment. Although the findings showed that patients who had previously taken and failed antiretroviral regimens were only half as likely to be in the better adherence categories and have virologic suppression than those new to therapy, they were equally likely to benefit from the MAPS intervention. Gross notes that for every 25 percent increase in antiretroviral drug doses taken, a patient's chance of having treatment success was doubled in the study.

Patients whose viral loads are suppressed are at much less risk of transmitting HIV to others in the community, so efforts to improve adherence stand to benefit the population at large.

"Importantly, we found that this intervention was equally effective for both patients who were just beginning therapy and those who had already been taking the drugs and had problems adhering, and it continued to be effective over time, unlike many approaches in which patients eventually fall into less adherent behavior," Gross says. "The effect we found also persisted even though the population we studied has many life challenges, including poverty and unemployment."

He and his colleagues suggest that the same approach could be utilized to improve treatment adherence for patients with Hepatitis C, heart failure, and other diseases, particularly if the MAPS process could be scaled back to require less interaction with interventionist, and if who may require "booster" sessions could be identified. The authors have made their Managed Problem Solving treatment manual available online for use by other clinicians, at http://www.med.upenn.edu/cceb/maps-form.shtml.

Explore further: Hepatitis C patients likely to falter in adherence to treatment regimen over time

Related Stories

Hepatitis C patients likely to falter in adherence to treatment regimen over time

September 29, 2011
Patients being treated for chronic hepatitis C become less likely to take their medications over time, according to a new study from the Perelman School of Medicine at the University of Pennsylvania. Since the study also ...

Can specialized HIV community pharmacies improve treatment?

August 14, 2012
Community pharmacies with specially trained staff to provide HIV services can help HIV-infected individuals be more compliant with their essential antiviral drug regimens and hence improve patient outcomes. Users of HIV-specialized ...

African-Americans face roadblocks to HIV therapy, untreated depression makes it worse

May 2, 2012
African-Americans with HIV are much less likely to adhere to drug therapy than others with the disease, according to a University of Michigan study.

Benefits of HIV drugs rise -- but less than previously believed, study shows

July 22, 2012
The percentage of HIV patients taking antiretroviral drugs who experienced the full benefit of the drugs jumped from 45 percent of 72 percent during the past decade, a figure that is lower than previous estimates. The findings, ...

5 Questions: Blaschke on patients who don't 'dose' properly

February 27, 2012
Your doctor writes out a prescription that calls for you to take a pill twice a day for the next month. So, that’s what you do, right? Wrong. A huge number of Americans fail to properly follow their doctors’ orders. ...

Recommended for you

Scientists divulge latest in HIV prevention

July 25, 2017
A far cry from the 1990s "ABC" campaign promoting abstinence and monogamy as HIV protection, scientists reported on new approaches Tuesday allowing people to have all the safe sex they want.

Girl's HIV infection seems under control without AIDS drugs

July 24, 2017
A South African girl born with the AIDS virus has kept her infection suppressed for more than eight years after stopping anti-HIV medicines—more evidence that early treatment can occasionally cause a long remission that, ...

Meds by monthly injection might revolutionize HIV care (Update)

July 24, 2017
Getting a shot of medication to control HIV every month or two instead of having to take pills every day could transform the way the virus is kept at bay.

Candidate AIDS vaccine passes early test

July 24, 2017
The three-decade-old quest for an AIDS vaccine received a shot of hope Monday when developers announced that a prototype triggered the immune system in an early phase of human trials.

Paris spotlight on latest in AIDS science

July 21, 2017
Some 6,000 HIV experts gather in Paris from Sunday to report advances in AIDS science as fading hopes of finding a cure push research into new fields.

Scientists elicit broadly neutralizing antibodies to HIV in calves

July 20, 2017
Scientists supported by the National Institutes of Health have achieved a significant step forward, eliciting broadly neutralizing antibodies (bNAbs) to HIV by immunizing calves. The findings offer insights for HIV vaccine ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.