Robert Gross|Scarlett L. Bellamy|Jennifer Chapman|Xiaoyan Han|Jacqueline O’Duor|Steven C. Palmer|Peter S. Houts|James C. Coyne|Brian L. Strom
Managed Problem Solving for Antiretroviral Therapy Adherence
adherence antiretroviral therapy critical successful treatment human immunodeficiency virus hiv interventions demonstrated improve adherence virologic outcomes sought determine whether intervention derived problem solving theory managed problem solving maps would improve antiretroviral outcomeswe conducted randomized investigator blind trial maps compared usual care hiv1 infected individuals 3 hiv clinics philadelphia pennsylvania eligible patients plasma hiv1 viral loads greater 1000 copiesml initiating changing therapy managed problem solving consists 4 inperson 12 telephonebased meetings trained interventionist monthly followup calls year primary outcome medication adherence measured using electronic monitors summarized fraction doses taken quarterly 1 year secondary outcome undetectable hiv viral load 1 year assessed 218 eligibility 190 eligible 180 enrolled 91 randomized maps 89 usual care fiftysix participants lost followup 33 maps group 23 usual care groupin primary intentiontotreat analyses odds higher adherence category 178 95 ci107296 times greater maps usual care secondary analyses odds undetectable viral load 148 95 ci 094231 times greater maps usual care astreated analyses effect maps stronger outcomes neither difference prior treatment status change effect timemanaged problem solving effective antiretroviral adherence intervention first year new regimen equally effective improving adherence treatment experienced nave patients lose effect time implementation maps strongly considered resources availableclinicaltrialsgov identifier nct00130273