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Application and Outcome of Two Strategies to Increase HIV Medication Adherence: Life-Steps and Medication Monitoring
S. A. SAFREN*1,2, M. W. OTTO1, J. L. WORTH1, W. A. JOHNSON2, S. BOSWELL2,
and K. MAYER2. 1Massachusetts Gen. Hosp. and Harvard Med. Sch. and 2Fenway
Community Hlth., Boston, MA.
Life-Steps is a single-session cognitive-behavioral intervention designed to increase adherence to HIV medication regimens. Eleven steps are targeted (e.g. adherence education and motivation, daily medication schedule, reminder cues). The Life-Steps program is suited for a variety of treatment facilities because the intervention protocol is manualized (available for distribution), and designed for use by any clinical specialist. Medication monitoring involves completing a daily pill diary and can also be easily implemented in a variety of settings.
The main outcome variable was self-reported adherence scores (number of pills taken divided by number of pills prescribed) on an adherence questionnaire for the past two weeks. First, we targeted persons receiving new or changed prescriptions for HIV medication (n = 27). Both treatment conditions were associated with significant improvements in adherence scores at Week 2 F(1,25 = 5.72), p < .05. Adherence scores were 86% (baseline) and 97% (two weeks after study entry). The 97% adherence score was maintained at Week 12. Second, we opened enrollment (and constrained analyses) to persons with defined problems of medication adherence (n = 56) in order to prevent a ceiling effect for improvement. While both groups improved F(1,54) = 15.01, p < .01, this was qualified by an interaction such that those in the Life-Steps condition showed greater short-term improvements than those in the medication monitoring condition F(1,54) = 4.41, p < .05 after two weeks. Week 2 adherence scores for the Medication Monitoring and Life-Steps conditions were 90% and 95% respectively. At the Week 12 assessment, the interaction was no longer significant, but there was a main effect for improvement in both conditions F(1,51) = 10.64, p < .01 (adherence scores = 93% and 94% for Medication Monitoring and Life-Steps respectively).
Even minimal interventions (e.g., having patients monitor their medications) may help many individuals increase their HIV medication adherence, whereas skills-building interventions may be more appropriate for faster improvement for persons with identified adherence problems .
Key Words: Adherence, Behavioral Science, Compliance
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