1. Couple-focused support to improve HIV medication adherence: a randomized controlled trial
- Author
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Tiffany M. Jung, Curtis Dolezal, Michael J. Stirratt, Glenn J. Wagner, Alex Carballo-Diéguez, Robert H. Remien, Nabila El-Bassel, and Joanna S. Dognin
- Subjects
Adult ,Male ,Gerontology ,medicine.medical_specialty ,Immunology ,Population ,Psychological intervention ,HIV Infections ,law.invention ,Social support ,Patient Education as Topic ,Randomized controlled trial ,Acquired immunodeficiency syndrome (AIDS) ,law ,Antiretroviral Therapy, Highly Active ,Humans ,Immunology and Allergy ,Medicine ,Outpatient clinic ,education ,education.field_of_study ,business.industry ,Case-control study ,Social Support ,Homosexuality ,medicine.disease ,Clinical trial ,Sexual Partners ,Infectious Diseases ,Physical therapy ,Patient Compliance ,Female ,New York City ,business - Abstract
To assess the efficacy of a couple-based intervention to improve medication-taking behavior in a clinic population with demonstrated adherence problems.A randomized controlled trial (SMART Couples Study) conducted between August 2000 and January 2004.Two HIV/AIDS outpatient clinics in New York City.Heterosexual and homosexual HIV-serodiscordant couples (n = 215) in which the HIV-seropositive partner had80% adherence at baseline. The sample was predominantly lower-income racial/ethnic minorities.Participants were randomly assigned to a four-session couple-focused adherence intervention or usual care. The intervention consisted of education about treatment and adherence, identifying adherence barriers, developing communication and problem-solving strategies, optimizing partner support, and building confidence for optimal adherence.Medication adherence at week 8 (2 weeks after the intervention) compared with baseline, assessed with a Medication Event Monitoring System cap.Intervention participants showed higher mean medication adherence at post-intervention when compared with controls whether adherence was defined as proportion of prescribed doses taken (76% versus 60%) or doses taken within specified time parameters (58% versus 35%). Also, participants in the intervention arm were significantly more likely to achieve high levels of adherence (80%,90%, or95%) when compared with controls. However, in most cases, effects diminished with time, as seen at follow-up at 3 and 6 months.The SMART Couples program significantly improved medication adherence over usual care, although the level of improved adherence, for many participants, was still suboptimal and the effect was attenuated over time.
- Published
- 2005
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