Kalichman Seth C, Katner Harold, Eaton Lisa A, Banas Ellen, Hill Marnie, Kalichman Moira O
Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT, USA.
Department of Medicine, Mercer University Medical School, Macon, GA, USA.
Transl Behav Med. 2021 Apr 7;11(3):852-862. doi: 10.1093/tbm/ibaa109.
With the expansion of telehealth services, there is a need for evidence-based treatment adherence interventions that can be delivered remotely to people living with HIV. Evidence-based behavioral health counseling can be delivered via telephone, as well as in-office services. However, there is limited research on counseling delivery formats and their differential outcomes. The purpose of this study was to conduct a head-to-head comparison of behavioral self-regulation counseling delivered by telephone versus behavioral self-regulation counseling delivered by in-office sessions to improve HIV treatment outcomes. Patients (N = 251) deemed at risk for discontinuing care and treatment failure living in a rural area of the southeastern USA were referred by their care provider. The trial implemented a Wennberg Randomized Preferential Design to rigorously test: (a) patient preference and (b) comparative effects on patient retention in care and treatment adherence. There was a clear patient preference for telephone-delivered counseling (69%) over in-office-delivered counseling (31%) and participants who received telephone counseling completed a greater number of sessions. There were few differences between the two intervention delivery formats on clinical appointment attendance, antiretroviral adherence, and HIV viral load. Overall improvements in health outcomes were not observed across delivery formats. Telephone-delivered counseling did show somewhat greater benefit for improving depression symptoms, whereas in-office services demonstrated greater benefits for reducing alcohol use. These results encourage offering most patients the choice of telephone and in-office behavioral health counseling and suggest that more intensive interventions may be needed to improve clinical outcomes for people living with HIV who may be at risk for discontinuing care or experiencing HIV treatment failure.
随着远程医疗服务的扩展，需要有基于证据的治疗依从性干预措施，以便能够远程提供给艾滋病毒感染者。基于证据的行为健康咨询可以通过电话以及门诊服务来提供。然而，关于咨询提供形式及其不同结果的研究有限。本研究的目的是对通过电话提供的行为自我调节咨询与通过门诊提供的行为自我调节咨询进行直接比较，以改善艾滋病毒治疗结果。居住在美国东南部农村地区、被其护理提供者认为有停止治疗风险和治疗失败风险的患者（N = 251）被转诊。该试验采用了Wennberg随机优先设计，以严格测试：（a）患者偏好，以及（b）对患者持续接受护理和治疗依从性的比较效果。与门诊咨询（31%）相比，患者明显更倾向于电话咨询（69%），并且接受电话咨询的参与者完成的咨询疗程更多。在临床预约就诊、抗逆转录病毒药物依从性和艾滋病毒病毒载量方面，两种干预提供形式之间几乎没有差异。在不同的提供形式中未观察到健康结果的总体改善。电话咨询在改善抑郁症状方面确实显示出更大的益处，而门诊服务在减少饮酒方面显示出更大的益处。这些结果鼓励为大多数患者提供电话和门诊行为健康咨询的选择，并表明可能需要更强化的干预措施来改善可能有停止护理风险或经历艾滋病毒治疗失败风险的艾滋病毒感染者的临床结果。
