Cue-dose training with monetary reinforcement: pilot study of an antiretroviral adherence intervention.
J Gen Intern Med
; 15(12): 841-7, 2000 Dec.
Article
em En
| MEDLINE
| ID: mdl-11119180
ABSTRACT
OBJECTIVE:
To assess the feasibility and efficacy of two interventions for improving adherence to antiretroviral therapy regimens in HIV-infected subjects compared with a control intervention.DESIGN:
Randomized, controlled, pilot study.SETTING:
Department of Veterans Affairs HIV clinic and community-based HIV clinical trials site.PARTICIPANTS:
Fifty-five HIV-infected subjects on stable antiretroviral therapy regimens. Subjects were predominantly male (89%) and African American (69%), and had histories of heroin or cocaine use (80%).INTERVENTIONS:
Four weekly sessions of either nondirective inquiries about adherence (control group, C), cue-dose training, which consisted of the use of personalized cues for remembering particular dose times, and feedback about medication taking using Medication Event Monitoring System (MEMS) pill bottle caps, which record time of bottle opening (CD group), or cue-dose training combined with cash reinforcement for correctly timed bottle opening (CD+CR). MEASUREMENTS Opening of the pill bottle within 2 hours before or after a predetermined time was measured by MEMS.RESULTS:
Adherence to the medication as documented by MEMS was significantly enhanced during the 4-week training period in the CD+CR group, but not in the CD group, compared with the control group. Improvement was also seen in adherence to antiretroviral drugs that were not the object of training and reinforcement. Eight weeks after training and reinforcement were discontinued, adherence in the cash-reinforced group returned to near-baseline levels.CONCLUSIONS:
Cue-dose training with cash reinforcement led to transient improvement in adherence to antiretroviral therapy in a population including mostly African Americans and subjects with histories of drug abuse. However, we were not able to detect any sustained improvement beyond the active training period, and questions concerning the timing and duration of such an intervention require further study. Randomized, controlled clinical studies with objective measures of adherence can be conducted in HIV-infected subjects and should be employed for further evaluation of this and other adherence interventions.
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Base de dados:
MEDLINE
Assunto principal:
Recompensa
/
Infecções por HIV
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Educação de Pacientes como Assunto
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Cooperação do Paciente
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Fármacos Anti-HIV
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Sinais (Psicologia)
Tipo de estudo:
Clinical_trials
Limite:
Female
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Humans
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Male
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Middle aged
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2000
Tipo de documento:
Article