J Clin Outcomes Manage
A randomized trial of educational materials, pillboxes, and mailings to improve adherence with antiretroviral therapy in an inner city HIV clinic
Levin TP, Klibanov OM, Axelrod P, van den Berg-Wolf M, Finley GL, Gray A, Holdsworth C, Moyer DV, Tedaldi EM, Samuel R
Abstract Objective: To determine whether interventions such as medication cards, pillboxes, and mailings of motivational messages would impact antiretroviral ad-herence in an inner city HIV clinic. Factors influencing adherence were also assessed. Methods: Patients were randomized to an adherence intervention protocol or to standard of care. Utilizing an adherence measurement tool, Medication Adherence Self-Report Inventory (MASRI), we assessed the im-pact of our interventions on rates of adherence over a 24-week period. Results: 50 patients were enrolled: 27 in the intervention group and 23 in the control group. Only 10 patients (20.4%) completed all study visits. Seven patients (14%) did not return after randomization. Cumulative adherence was 96.7% in the intervention group and 97.4% in the control group (p > 0.05). Factors predicting adherence included baseline CD4 count (CD4 < 200 cells/mm3, 90% adherence versus CD4 > 200 cells/mm3, 99% adherence; p = 0.03) and active illicit drug use (83% versus 97.4%; p = 0.37). There was no difference based on intervention in CD4 increase or HIV viral load decline at the end of the study period. Conclusions: Adherence interventions did not result in significant differences in rates of adherence or other outcomes in our study. Baseline lower CD4 counts and active drug use contributed to poorer adherence. High dropout rates in our study suggest that although focusing on adherence is a key aspect of HIV care, finding ways to increase patient retention should also be a priority.
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