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Effect of individual cognitive behaviour intervention on adherence to antiretroviral therapy: prospective randomized trial.

Abstract

OBJECTIVE

A high level of adherence to antiretroviral therapy is required for complete suppression of HIV replication, immunological and clinical effectiveness. We investigated whether cognitive behaviour therapy can improve medication adherence.

DESIGN

Prospective randomized 1-year trial.

SETTING

Collaboration of HIV university outpatient clinic and psychotherapists in private practice.

PARTICIPANTS

60 HIV-infected persons on stable antiretroviral combination therapy and viral load below 50 copies/ml.

INTERVENTION

Cognitive behaviour intervention in individual patients, in addition to standard of care.

MAIN OUTCOME MEASURES

Feasibility and acceptance of intervention; adherence to therapy assessed using medication event monitoring system (MEMS) and self-report questionnaire; virological failure; psychosocial measures.

RESULTS

The median number of sessions for cognitive behaviour intervention per patient during the 1-year trial was 11 (range 2-25). At months 10-12, mean adherence to therapy as assessed using MEMS was 92.8% in the intervention and 88.9% in the control group (P=0.2); the proportion of patients with adherence > or = 95% was 70 and 50.0% (P=0.014), respectively. While there was no significant deterioration of adherence during the study in the intervention arm, adherence decreased by 8.7% per year (P=0.006) in the control arm. No differences between the intervention group and standard of care group were found regarding virological outcome. Compared with the control group, participants in the intervention group perceived a significant improvement of their mental health during the study period.

CONCLUSIONS

Cognitive behavioural support in addition to standard of care of HIV-infected persons is feasible in routine practice, and can improve medication adherence and mental health.

Authors+Show Affiliations

,

Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, Switzerland. infweb@usz.unizh.ch

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Source

Antiviral therapy 9:1 2004 Feb pg 85-95

MeSH

Adult
Aged
Anti-HIV Agents
Cognition
Drug Monitoring
Educational Status
Female
HIV Infections
HIV-1
Humans
Male
Middle Aged
Patient Compliance
Prospective Studies
Psychotherapy
RNA, Viral
Surveys and Questionnaires
Time Factors
Viral Load

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15040540

Citation

Weber, Rainer, et al. "Effect of Individual Cognitive Behaviour Intervention On Adherence to Antiretroviral Therapy: Prospective Randomized Trial." Antiviral Therapy, vol. 9, no. 1, 2004, pp. 85-95.
Weber R, Christen L, Christen S, et al. Effect of individual cognitive behaviour intervention on adherence to antiretroviral therapy: prospective randomized trial. Antivir Ther (Lond). 2004;9(1):85-95.
Weber, R., Christen, L., Christen, S., Tschopp, S., Znoj, H., Schneider, C., ... Ledergerber, B. (2004). Effect of individual cognitive behaviour intervention on adherence to antiretroviral therapy: prospective randomized trial. Antiviral Therapy, 9(1), pp. 85-95.
Weber R, et al. Effect of Individual Cognitive Behaviour Intervention On Adherence to Antiretroviral Therapy: Prospective Randomized Trial. Antivir Ther (Lond). 2004;9(1):85-95. PubMed PMID: 15040540.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of individual cognitive behaviour intervention on adherence to antiretroviral therapy: prospective randomized trial. AU - Weber,Rainer, AU - Christen,Lisanne, AU - Christen,Stephan, AU - Tschopp,Simone, AU - Znoj,Hansjoerg, AU - Schneider,Christine, AU - Schmitt,Joachim, AU - Opravil,Milos, AU - Günthard,Huldrych F, AU - Ledergerber,Bruno, AU - ,, PY - 2004/3/26/pubmed PY - 2004/7/15/medline PY - 2004/3/26/entrez SP - 85 EP - 95 JF - Antiviral therapy JO - Antivir. Ther. (Lond.) VL - 9 IS - 1 N2 - OBJECTIVE: A high level of adherence to antiretroviral therapy is required for complete suppression of HIV replication, immunological and clinical effectiveness. We investigated whether cognitive behaviour therapy can improve medication adherence. DESIGN: Prospective randomized 1-year trial. SETTING: Collaboration of HIV university outpatient clinic and psychotherapists in private practice. PARTICIPANTS: 60 HIV-infected persons on stable antiretroviral combination therapy and viral load below 50 copies/ml. INTERVENTION: Cognitive behaviour intervention in individual patients, in addition to standard of care. MAIN OUTCOME MEASURES: Feasibility and acceptance of intervention; adherence to therapy assessed using medication event monitoring system (MEMS) and self-report questionnaire; virological failure; psychosocial measures. RESULTS: The median number of sessions for cognitive behaviour intervention per patient during the 1-year trial was 11 (range 2-25). At months 10-12, mean adherence to therapy as assessed using MEMS was 92.8% in the intervention and 88.9% in the control group (P=0.2); the proportion of patients with adherence > or = 95% was 70 and 50.0% (P=0.014), respectively. While there was no significant deterioration of adherence during the study in the intervention arm, adherence decreased by 8.7% per year (P=0.006) in the control arm. No differences between the intervention group and standard of care group were found regarding virological outcome. Compared with the control group, participants in the intervention group perceived a significant improvement of their mental health during the study period. CONCLUSIONS: Cognitive behavioural support in addition to standard of care of HIV-infected persons is feasible in routine practice, and can improve medication adherence and mental health. SN - 1359-6535 UR - https://www.unboundmedicine.com/medline/citation/15040540/full_citation L2 - http://hivinsite.ucsf.edu/InSite?page=kb-03-02-09 DB - PRIME DP - Unbound Medicine ER -