Remien Robert H, Stirratt Michael J, Dolezal Curtis, Dognin Joanna S, Wagner Glenn J, Carballo-Dieguez Alex, El-Bassel Nabila, Jung Tiffany M
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York 10032, USA.
AIDS. 2005 May 20;19(8):807-14. doi: 10.1097/01.aids.0000168975.44219.45.
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 had < 80% 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%, or > 95%) 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.
评估一项基于伴侣的干预措施对改善存在用药依从性问题的门诊患者用药行为的效果。
2000年8月至2004年1月进行的一项随机对照试验（SMART伴侣研究）。
纽约市的两家艾滋病毒/艾滋病门诊诊所。
艾滋病毒血清学结果不一致的异性恋和同性恋伴侣（n = 215），其中艾滋病毒血清学阳性的伴侣在基线时的依从率<80%。样本主要是低收入的少数种族/族裔。
参与者被随机分配到一个为期四节的以伴侣为重点的依从性干预组或常规护理组。干预措施包括关于治疗和依从性的教育、识别依从性障碍、制定沟通和解决问题的策略、优化伴侣支持以及建立最佳依从性的信心。
与基线相比，在第8周（干预后2周）时的用药依从性，使用药物事件监测系统帽进行评估。
与对照组相比，干预组参与者在干预后显示出更高的平均用药依从性，无论依从性是定义为服用的规定剂量比例（76%对60%）还是在特定时间参数内服用的剂量（58%对35%）。此外，与对照组相比，干预组的参与者更有可能达到高依从水平（>80%、>90%或>95%）。然而，在大多数情况下，随着时间的推移效果会减弱，在3个月和6个月的随访中可以看到。
SMART伴侣计划比常规护理显著提高了用药依从性，尽管对许多参与者来说，依从性改善的水平仍然不理想，且效果随着时间的推移而减弱。
