Spratt E S, Papa C E, Mueller M, Patel S, Killeen T, Maher E, Drayton C, Dixon T C, Fowler S L, Treiber F
Department of Pediatrics, Medical University of South Carolina, USA.
College of Nursing, Medical University of South Carolina, USA.
J Gen Med (Dover). 2017;1(1). Epub 2017 Sep 21.
In transitional age youth living with HIV or AIDS, non-adherence (<80%) to anti-retroviral medication is associated with viral resistance, disease progression, and an increased risk of death. This feasibility study investigated the Maya MedMinder electronic pillbox and cell phone texting with personalized motivational interviewing strategies to improve medication adherence in non-adherent youth. Twenty patients out of 30 identified as non-adherent by the Pediatric HIV team at the Medical University of South Carolina were approached, and 15 were recruited (Ages 12 to 20; 13.3% male, 86.7% female; 100% African-American). Following baseline MedMinder monitoring, subjects were randomized to intervention groups with reminder signals on or off. The time medications were taken was collected by the MedMinder, resulting in adherence scores. All were interviewed for readiness to change utilizing the Motivational Interviewing (MI) Stages of Change scores. Viral load and CD4 labs were scheduled every 6 weeks. Despite monetary incentives and personalized support, recruitment and adherence to the protocol was a challenge. Only 6/15 subjects completed the entire study scheduled for 6-months .Stages of change scores revealed that those that transitioned to making changes had higher CD4 percentages midway through the study. Challenges included missed appointments and labs despite efforts by text and phone to schedule convenient appointment times with participants. Device challenges included the large size of the MedMinder and faulty electronic signaling, especially from rural areas. The methodology was feasible with these patients. This small feasibility study highlights that technological tools to promote adherence and motivational enhancement strategies in teens and young adults who are non-adherent to HIV medication regimens can enhance biomarker outcomes associated with medication adherence.
在处于过渡年龄且感染艾滋病毒或患艾滋病的青少年中，抗逆转录病毒药物治疗的不依从（<80%）与病毒耐药性、疾病进展以及死亡风险增加相关。这项可行性研究调查了玛雅医疗提醒电子药盒以及结合个性化动机访谈策略的手机短信，以提高不依从治疗的青少年的药物依从性。南卡罗来纳医科大学的儿科艾滋病毒治疗团队确定的30名不依从治疗的患者中，有20名被邀请参与研究，15名被招募（年龄在12至20岁之间；男性占13.3%，女性占86.7%；100%为非裔美国人）。在进行基线医疗提醒监测后，受试者被随机分为提醒信号开启或关闭的干预组。医疗提醒设备记录服药时间，得出依从性得分。所有受试者均接受访谈，使用动机访谈的改变阶段得分来评估改变意愿。每6周安排一次病毒载量和CD4检测。尽管有金钱激励和个性化支持，但招募受试者并使其遵守研究方案仍是一项挑战。只有6/15的受试者完成了预定为期6个月的整个研究。改变阶段得分显示，那些过渡到做出改变的受试者在研究进行到一半时CD4百分比更高。挑战包括尽管通过短信和电话努力为参与者安排方便的预约时间，但仍错过预约和检测。设备方面的挑战包括医疗提醒设备体积大以及电子信号故障，尤其是在农村地区。该方法对这些患者是可行的。这项小型可行性研究表明，对于不遵守艾滋病毒药物治疗方案的青少年和年轻人，促进依从性的技术工具和动机增强策略可以改善与药物依从性相关的生物标志物结果。
