Document Detail

Managed problem solving for antiretroviral therapy adherence: a randomized trial.
MedLine Citation:
PMID:  23358784     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Adherence to antiretroviral therapy is critical to successful treatment of human immunodeficiency virus (HIV). Few interventions have been demonstrated to improve both adherence and virologic outcomes. We sought to determine whether an intervention derived from problem solving theory, Managed Problem Solving (MAPS), would improve antiretroviral outcomes.
METHODS: We conducted a randomized investigator blind trial of MAPS compared with usual care in HIV-1 infected individuals at 3 HIV clinics in Philadelphia, Pennsylvania. Eligible patients had plasma HIV-1 viral loads greater than 1000 copies/mL and were initiating or changing therapy. Managed Problem Solving consists of 4 in-person and 12 telephone-based meetings with a trained interventionist, then monthly follow-up calls for a year. Primary outcome was medication adherence measured using electronic monitors, summarized as fraction of doses taken quarterly over 1 year. Secondary outcome was undetectable HIV viral load over 1 year. We assessed 218 for eligibility, with 190 eligible and 180 enrolled, 91 randomized to MAPS and 89 to usual care. Fifty-six participants were lost to follow-up: 33 in the MAPS group and 23 in usual care group.
RESULTS: In primary intention-to-treat analyses, the odds of being in a higher adherence category was 1.78 (95% CI,1.07-2.96) times greater for MAPS than usual care. In secondary analyses, the odds of an undetectable viral load was 1.48 (95% CI, 0.94-2.31) times greater for MAPS than usual care. In as-treated analyses, the effect of MAPS was stronger for both outcomes. There was neither a difference by prior treatment status nor change in effect over time.
CONCLUSIONS: Managed Problem Solving is an effective antiretroviral adherence intervention over the first year with a new regimen. It was equally effective at improving adherence in treatment experienced and naïve patients and did not lose effect over time. Implementation of MAPS should be strongly considered where resources are available.
TRIAL REGISTRATION: Identifier: NCT00130273.
Robert Gross; Scarlett L Bellamy; Jennifer Chapman; Xiaoyan Han; Jacqueline O'Duor; Steven C Palmer; Peter S Houts; James C Coyne; Brian L Strom
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  JAMA internal medicine     Volume:  173     ISSN:  2168-6114     ISO Abbreviation:  JAMA Intern Med     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-26     Completed Date:  2013-04-16     Revised Date:  2013-10-22    
Medline Journal Info:
Nlm Unique ID:  101589534     Medline TA:  JAMA Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  300-6     Citation Subset:  AIM; IM    
Division of Infectious Diseases, Department of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104-6021, USA.
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MeSH Terms
Anti-HIV Agents / administration & dosage*
Antiretroviral Therapy, Highly Active / methods*
HIV Infections / drug therapy*,  virology
HIV-1 / drug effects*
Intention to Treat Analysis
Logistic Models
Medication Adherence / psychology*
Middle Aged
Patient Compliance / psychology*
Problem Solving*
Single-Blind Method
Treatment Outcome
Viral Load
Grant Support
Reg. No./Substance:
0/Anti-HIV Agents
Comment In:
JAMA Intern Med. 2013 Feb 25;173(4):306-7   [PMID:  23358810 ]
JAMA Intern Med. 2013 Aug 12;173(15):1474   [PMID:  23939522 ]
JAMA Intern Med. 2013 Aug 12;173(15):1475-6   [PMID:  23939524 ]

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