Randomized Factorial Trial of Phone-Delivered Support Counseling and Daily Text Message Reminders for HIV Treatment Adherence

• Type of Material: Article
• Authors: Seth C. Kalichman, University of Connecticut; Moira O. Kalichman, University of Connecticut; Chauncey Cherry, University of Connecticut; Lisa A. Eaton, University of Connecticut; Dean Cruess, University of Connecticut; Raymond Schinazi, Emory University
• Language: English
• Date: 2016-09-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/QAI.0000000000001020
• Title of Journal or Parent Work: Journal of Acquired Immune Deficiency Syndromes
• ISSN: 1525-4135
• Volume: 73
• Issue: 1
• Start Page: 47
• End Page: 54
• Grant/Funding Information: Schinazi was supported by the Center for AIDS Research, Emory University School of Medicine, National Institutes of Health (NIH) grant P30-AI050409 and the Department of Veterans Affairs.; This project was supported by National Institute of Nursing Research Grant R01-NR012962, Kalichman, PI.
• Keywords: INTERVENTIONS; METAANALYSIS; Life Sciences & Biomedicine; mHealth; HAART-ADHERENCE; Infectious Diseases; Counseling; ANTIRETROVIRAL THERAPY ADHERENCE; VALIDITY; Self-regulation counseling; CARE; counseling; PROGRAM; Science & Technology; behavioral intervention; IMPROVE MEDICATION ADHERENCE; Immunology; Behavioral intervention; RELIABILITY; adherence support; OF-THE-LITERATURE; HIV treatment; Adherence support; Adherence
• Research Categories: Biology, Virology; Health Sciences, Immunology; Biology, Microbiology

Abstract

Background: HIV infection is clinically managed with antiretroviral therapy (ART), but only with sustained adherence. Cost-efficient interventions to improve and sustain ART adherence remain a pressing priority for populations challenged by nonadherence. The aim of this study was to test the independent and interactive effects of (1) brief phone-delivered self-regulation counseling and (2) daily phone-delivered text message medication reminders on HIV adherence and HIV viral suppression. Method: A randomized 2 (5 sessions of phone-delivered adherence support counseling vs. contact-matched control) × 2 (daily ART text reminders vs. no reminders) trial with primary end points of monthly phone-based unannounced pill count-determined ART adherence and HIV viral suppression monitored over 12 months. Results: Self-regulation adherence counseling demonstrated significant improvements in achieving 90% ART adherence relative to the control group over the first 6 months of follow-up. Effects remained significant in sensitivity analyses conducted at 85% and 95% adherence. Counseling also demonstrated modest but significant effects on HIV suppression. There were no main effects or interactions for daily text message reminders, with some evidence for adverse effects on adherence self-efficacy. Conclusions: Brief adherence support counseling delivered by phone demonstrates clinically meaningful improvements in ART adherence and HIV suppression, although these benefits were not evidenced in all patients or in the long-term. Advancing adherence interventions along with an effective means for sustaining gains in adherence remain priorities if ART is to achieve its potential clinical and public health benefits.