Modifying Facilitators and Barriers to HIV Adherence

DESCRIPTION (provided by applicant): Adherence to antiretroviral medications is now a key component to maintaining health for persons living with HIV/AIDS. However, adherence to antiretroviral medications in HIV disease is a major challenge because of the numbers and timing of medications and the distressing side effects. Deviation in time between doses may result in production of drug-resistant strains of the virus, compromising subsequent therapy for the patient. Practical valid approaches to enhance adherence to antiretroviral medications are needed. Previous studies on adherence to medications indicate that it is a complex phenomenon best addressed by multidimensional interventions tailored to the individual's schedule and lifestyle. This study builds upon the principal investigator's previous qualitative studies in which persons living with HIV described their perceptions of facilitators and barriers to taking their medication as well as strategies they used to maintain adherence. From these stories there emerged a theoretical framework "Creating a New Normal" in which clients' confront the need for medications, mobilize available resources, and overcome barriers to adherence, thereby integrating medication adherence into their lives. Based on this framework, we will pilot test an intervention that assists clients to improve adherence to HIV medications by creating and mobilizing family and community resources to overcome barriers and integrate the treatment regimen into their lives. The setting for the study is an infectious disease clinic in a southeastern state that provides health services to clients with HIV (over 66 percent are African Americans and 40 percent are women) from surrounding rural and semi-rural areas. A randomized two-group (n = 44 per group) factorial design with repeated measures will test the effect of an intervention consisting of individualized assessment, education, counseling, and referrals administered by a research nurse in face-to-face and follow-up telephone sessions over a 3-month period. Adherence to all prescribed medications will be measured at times 1, 2, and 3, by self-report, and pill counts, and to one antiretroviral medication by electronic monitor in the container. Information gained from this study will be used to design a large randomized clinical intervention trial study.