Personalized Strategies to Address Barriers to HIV Drug Adherence Boost Chances of Successful Therapy, Penn Medicine Study Shows

HIV patients who participated in an intervention that helped them identify barriers to taking their drugs properly and develop customized coping strategies took a significantly greater amount of their prescribed doses than those receiving standard care, according to a new study from researchers in the Perelman School of Medicine at the University of Pennsylvania. The results, published this week in JAMA Internal Medicine, may point to a new strategy to improve adherence to medications for many other conditions.

“Nonadherence to medical therapy is a silent epidemic that undercuts physicians’ efforts to treat diseases from high cholesterol and hypertension to HIV and diabetes,” says the new study’s lead author, Robert Gross, MD, MSCE, an associate professor of Infectious Diseases and Epidemiology. “We tend to view the problem as either a failure on our part or on the patient’s part, but the results of our new study show that we can do our jobs better by sharing the planning role with them to overcome possible stumbling blocks to taking their prescribed drugs.”

Antiretroviral drugs have turned HIV/AIDS into a manageable, chronic condition for many patients who would have died of the disease before the development of these medications, but they require lifelong adherence to be effective. The drugs have short half lives and need to be in the patients’ system at all time in order to keep the virus from replicating, so frequently missing doses drastically cuts the chances that treatment will be successful. Predicting which patients will adhere to therapy has proven difficult.

“The barriers to taking these drugs properly are not universal – for some patients, substance abuse or depression might undercut efforts to stay on track, and for others, the complexity of the dosing regimen may pose a problem. Side effects – both real and perceived – can impact adherence, and psychosocial issues like low health literacy or a chaotic lifestyle can interfere, too,” Gross says. “We know from previous research that these issues cannot be overcome by simple education or simple technology alone, and financial incentives typically don’t produce a sustained effect.”

The researchers studied 180 patients receiving care at three Philadelphia HIV clinics, who were divided into two groups, one of which was randomized to a Managed Problem Solving (MAPS) group, and the other to usual care, which included a meeting with a pharmacist for drug regimen education and the provision of pill organizers. In order to study the benefit of the intervention, only patients who had detectable viral loads were enrolled.

With the help of a trained lay interventionist, MAPS participants received education about their newly prescribed drug regimen and then were taken through a process for identifying their personal barriers to adherence, brainstorming potential solutions, selecting the best option and monitoring its implementation. Potential solutions included memory and cognitive aids to remember to take and refill the drugs, ways to use social supports, and resources to seek help for depression or drug side effects. These plans were made during four initial in-person sessions and 12 telephone meetings that provided help for solving new problems and offering encouragement for obtaining refills and maintaining their regimens. Both groups’ adherence to their drug regimen was recorded through the use of an electronically monitored pill bottle.