Preventing Medication Nonadherence of Youth (13–24 Years) With HIV Initiating Antiretroviral Therapy

• Published in: Journal of adolescent health Vol. 69; no. 4; pp. 644 - 652
• Main Authors: Ingerski, Lisa M., Means, Bethany, Wang, Fang, Zhang, Hui, Patel, Nehali, Gaur, Aditya H., Wilkins, Megan L.
• Format: Journal Article
• Language: English
• Published: New York Elsevier Inc 01-10-2021; Elsevier BV
• Subjects: Adherence; Antiretroviral drugs; Antiretroviral therapy; Brief interventions; Clinical research; Clinical trials; Drugs; Efficacy; Feasibility; HIV; Horizontally acquired HIV; Human immunodeficiency virus; Integrated care; Intervention; Medical diagnosis; Medication adherence; Patient compliance; Pharmacy; Recruitment; Young adults; Intervention; Medication adherence; Horizontally acquired HIV
• ISSN: 1054-139X; 1879-1972
• DOI: 10.1016/j.jadohealth.2021.04.006

The objective of this study was to evaluate the feasibility and acceptability of a dynamic, behavioral intervention to optimize medication adherence of adolescents and young adults (AYAs) with HIV newly initiating highly active antiretroviral therapy (HAART) and explore its efficacy on adherence and disease outcomes.
The two-arm randomized controlled trial piloted a brief, individualized intervention designed for direct integration into standard clinical care. In total, 32 AYAs with a confirmed HIV diagnosis, reportedly horizontally acquired, and recommended to initiate HAART completed a two-week placebo trial before HAART initiation and were subsequently randomized to standard of care or the individualized intervention. Adherence and disease outcomes were measured over the first six months of HAART.
Results supported the primary study aim regarding feasibility (recruitment = 89%, attendance = 81%–100%, intervention exercise completion = 100%) and acceptability (average favorable response = 89%). Data also supported the positive effect of the intervention on select HAART adherence measures and disease outcomes. Adherence (by pharmacy refill) declined in both groups; however, adherence declined more slowly in the intervention group versus standard of care (p < .001). In addition, 100% of participants receiving the intervention obtained an undetectable viral load by 3 months and maintained an undetectable viral load at 6 months (vs. 68.8% standard of care).
This is one of the first interventions to target adherence for AYAs with HIV newly initiating HAART and designed for delivery in existing clinical care settings. Future research will help confirm efficacy and the potential utility of the intervention in promoting HAART adherence from medication initiation and preventing the decrease in adherence often observed over time.