Letourneau Elizabeth J, Ellis Deborah A, Naar-King Sylvie, Chapman Jason E, Cunningham Phillippe B, Fowler Sandra
Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA.
AIDS Care. 2013;25(4):507-14. doi: 10.1080/09540121.2012.715134. Epub 2012 Aug 22.
Adherence to antiretroviral medication for the treatment of HIV is a significant predictor of virologic suppression and is associated with dramatic reductions in mortality and morbidity and other improved clinical outcomes for pediatric patient populations. Effective strategies for addressing adherence problems in youth infected with HIV are needed and require significant attention to the complex interplay of multiple, interacting causal risk factors that lead to poor self-care. Within the context of a pilot randomized trial, we evaluated the feasibility and initial efficacy of a multisystemic therapy (MST) intervention adapted to address HIV medication adherence problems against a usual care condition that was bolstered with a single session of motivational interviewing (MI). For 34 participating youth, health outcomes (viral load [VL] and CD4 count) were obtained from approximately 10 months pre-baseline through approximately 6 months post-baseline and self-reported medication adherence outcomes were obtained quarterly from baseline through 9 months post-baseline. Using mixed-effects regression models we examined within- and between-groups differences in the slopes of these outcomes. Feasibility was supported, with a 77% recruitment rate and near-maximal treatment and research retention and completion rates. Initial efficacy also was supported, with the MST condition but not the MI condition demonstrating statistically and clinically significant VL reductions following the start of treatment. There was also some support for improved CD4 count and self-reported medication adherence for the MST but not the MI condition. MST was successfully adapted to improve the health outcomes of youth poorly adherent to antiretroviral medications. Replication trials and studies designed to identify the mechanisms of action are important next steps.
坚持服用抗逆转录病毒药物治疗艾滋病毒是病毒学抑制的一个重要预测指标，与儿科患者群体的死亡率和发病率显著降低以及其他临床结局改善相关。需要有效的策略来解决感染艾滋病毒青少年的服药依从性问题，这需要高度关注导致自我护理不佳的多个相互作用的因果风险因素之间的复杂相互作用。在一项试点随机试验的背景下，我们评估了一种多系统治疗（MST）干预措施针对常规护理条件（通过单次动机性访谈（MI）得到加强）来解决艾滋病毒药物依从性问题的可行性和初步疗效。对于34名参与试验的青少年，从基线前约10个月到基线后约6个月获取健康结局（病毒载量[VL]和CD4细胞计数），并从基线到基线后9个月每季度获取自我报告的药物依从性结局。我们使用混合效应回归模型研究了这些结局斜率的组内和组间差异。可行性得到了支持，招募率为77%，治疗和研究的保留率及完成率接近最高水平。初步疗效也得到了支持，MST组而非MI组在治疗开始后病毒载量出现了具有统计学意义和临床意义的下降。对于MST组而非MI组，CD4细胞计数和自我报告的药物依从性也有一定改善。MST成功地进行了调整，以改善抗逆转录病毒药物依从性差的青少年的健康结局。下一步重要的是进行复制试验和旨在确定作用机制的研究。
