Konkle-Parker Deborah J, Erlen Judith A, Dubbert Patricia M, May Warran
Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania Department of Mental Health, G.V. (Sonny) Montgomery Veterans Administration Medical Center, Jackson, Mississippi University of Mississippi Medical Center, Jackson, Mississippi.
J Am Acad Nurse Pract. 2012 Aug;24(8):488-98. doi: 10.1111/j.1745-7599.2012.00712.x. Epub 2012 Apr 30.
Strict adherence to HIV medications is critical to ensure long-term disease control, and adherence interventions that are possible in a clinic setting with limited resources are needed.
This randomized controlled pilot study tested an adherence intervention guided by the Information-Motivation-Behavioral Skills (IMB) model. The intervention included HIV education, a peer video, motivational interviewing, and attention to behavioral skills including communication with providers and adherence-enhancing devices. Dependent variables included 3-4 week adherence recall, medication refill rate, changes in IMB subscale scores, appointment attendance, and HIV-associated laboratory findings. Seventy-three individuals starting or restarting antiretroviral therapy were enrolled and 56 were randomized.
Improvements were seen in most outcomes, with small to moderate effect sizes, but the study was not powered to show statistical significance. Threats to power included a 51% attrition rate, resulting mostly from loss to clinical care or prolonged gaps in care.
A telephone-based intervention to improve HIV medication adherence shows promise. Further study is needed with greater attention to retention in care.
严格坚持服用抗艾滋病毒药物对于确保长期疾病控制至关重要，因此需要在资源有限的临床环境中可行的坚持治疗干预措施。
这项随机对照试验性研究测试了一种以信息 - 动机 - 行为技能（IMB）模型为指导的坚持治疗干预措施。该干预措施包括艾滋病毒教育、同伴视频、动机性访谈，以及对行为技能的关注，包括与医护人员沟通和使用提高依从性的设备。因变量包括3 - 4周的依从性回忆、药物 refill率、IMB子量表得分变化、预约就诊率以及与艾滋病毒相关的实验室检查结果。73名开始或重新开始抗逆转录病毒治疗的个体被纳入研究，56名被随机分组。
大多数结果都有改善，效应大小为小到中等，但该研究没有足够的效力显示统计学显著性。效力的威胁包括51%的损耗率，主要是由于失去临床护理或护理间隔延长。
一种基于电话的改善艾滋病毒药物依从性的干预措施显示出了前景。需要进一步研究，更加关注护理中的留存率。
