Effectiveness and cost-effectiveness of a nurse-delivered intervention to improve adherence to treatment for HIV: a pragmatic, multicentre, open-label, randomised clinical trial

Bruin, Marijn de; Oberjé, E.; Viechtbauer, Wolfgang; Nobel, H.; Hiligsmann, Mickaël; Nieuwkoop, Cees van; Veenstra, J.; Pijnappel, F.J.J.; Kroon, F.P.; Zonneveld, Laura van; Groeneveld, P. H. P.; Broekhuizen, Marjolein van; Evers, Silvia M. A. A.; Prins, Jan M.

doi:10.1016/s1473-3099(16)30534-5

Cited by 96 publications

(81 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition to stressful events, participants reported a wide range of environmental factors which impacted on their ability to adhere. Being able to plan how to overcome these barriers or ‘coping planning’ (Sniehotta et al ., ) is also likely to be an important part of a successful intervention to improve adherence (de Bruin et al ., ).…”

Section: Discussionmentioning

confidence: 97%

“…Participants across the board reported that, at least on occasion, they struggled to plan to take nebulizers and most highlighted the importance of routines in being able to adhere. Action planning (Sniehotta, Schwarzer, Scholz, & Schüz, ) is therefore likely to be an important component and has been used successfully in interventions to increase adherence to medication in other conditions (de Bruin et al ., ; O'Carroll et al ., ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Adherence to medication in adults with Cystic Fibrosis: An investigation using objective adherence data and the Theoretical Domains Framework

Arden

Drabble

O’Cathain

et al. 2019

British J Health Psychol

View full text Add to dashboard Cite

Objectives Adherence to nebulizer treatment in adults with Cystic Fibrosis ( CF ) is poor, and interventions are needed. This research aimed to identify the factors affecting nebulizer adherence using the Theoretical Domains Framework (TDF) and to compare these for participants with different levels of adherence. Design Data‐prompted interviews using the TDF. Methods Eighteen semi‐structured interviews were conducted with adults with CF during which objectively measured adherence data were discussed. Framework analysis was used to code the data into TDF domains, and inductive qualitative content analysis was used to code different beliefs and experiences. Aspects of the TDF that differed between participants with different adherence levels were explored. Results Factors influencing adherence to treatment included all 14 domains of the TDF , 10 of which appeared to vary by adherence level: Skills; Memory and decision‐making; and Behavioural regulation; Environmental context and resources; Social influences; Beliefs about consequences; Beliefs about capability; Reinforcement; Social role and identify; Intentions; Optimism; and Emotions. Conclusions This study is the first to use objectively measured adherence data in a data‐prompted interview using the TDF framework to systematically assess the full range of factors potentially influencing adherence. The results highlighted that interventions need to consider issues of capability, opportunity, and motivation. Interventions that challenge dysfunctional beliefs about adherence and which support the development of routines or habits and problem‐solving may be particularly useful for adults with CF . Statement of contribution What is already known? Adherence to medication in adults with cystic fibrosis is poor. Previous research has identified a range of contributing factors in relation to subjective reports of adherence. There is a wide discrepancy between self‐reported adherence and objectively measured adherence. What this study adds A data‐prompted interview using objectively measured adherence data enabled the systematic assessment of potential factors that could be targeted in an intervention to increase adherence. There were some differences in the factors that were identified by high and low adherers. There is not one‐size fits all intervention for adherence to medication in cystic fibrosis.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Adherence to medication in adults with Cystic Fibrosis: An investigation using objective adherence data and the Theoretical Domains Framework

Arden

Drabble

O’Cathain

et al. 2019

British J Health Psychol

View full text Add to dashboard Cite

show abstract

“…Another economic evaluation reached similar conclusions: an 18-month study using electronic medication monitors to improve viral load was also found to be cost-effective with a per person QALY gain only 15% different than the lifetime estimate in this analysis. 62 The study has several strengths and limitations. The strengths include the large study size, the availability of patient-level laboratory data, and the use of two reference cases (societal and health care sector).…”

Section: Discussionmentioning

confidence: 99%

The Cost-Effectiveness of Financial Incentives for Viral Suppression: HPTN 065 Study

et al. 2019

View full text Add to dashboard Cite

Objective: To evaluate the cost-effectiveness of financial incentives for human immunodeficiency virus (HIV) viral suppression compared to standard of care. Study Design: Mathematical model of 2-year intervention offering financial incentives ($70 quarterly) for viral suppression (<400 copies/ml 3 ) based on the HPTN 065 clinical trial with HIV patients in the Bronx, NY and Washington, D.C. Methods: A disease progression model with HIV transmission risk equations was developed following guidelines from the Second Panel on Cost-Effectiveness in Health and Medicine. We used health care sector and societal perspectives, 3% discount rate, and lifetime horizon. Data sources included trial data (baseline N ¼ 16,208 patients), CDC HIV Surveillance data, and published literature. Outcomes were costs (2017 USD), quality-adjusted life years (QALYs), HIV infections prevented, and incremental cost-effectiveness ratio (ICER). Results: Financial incentives for viral suppression were estimated to be costsaving from a societal perspective and cost-effective ($49,877/QALY) from a health care sector perspective. Compared to the standard of care, financial incentives gain 0.06 QALYs and lower discounted lifetime costs by $4210 per patient. The model estimates that incentivized patients transmit 9% fewer infections than the standard-of-care patients. In the sensitivity analysis, ICER 95% credible intervals ranged from cost-saving to $501,610/QALY with 72% of simulations being cost-effective using a $150,000/QALY threshold. Modeling results are limited by uncertainty in efficacy from the clinical trial. Conclusions: Financial incentives, as used in HTPN 065, are estimated to improve quality and length of life, reduce HIV transmissions, and save money from a societal perspective. Financial incentives offer a promising option for enhancing the benefits of medication in the United States.

show abstract

“…Re-engaging OOC patients is considered within the scope of nursing practice and, despite a lack of formal or systematic efforts by nurses in the current model of care, their involvement in re-engagement efforts is likely to be key. Indeed, their clinical experience and knowledge about patients could be helpful in determining how and when patients should be re-engaged into care [13,14].…”

Section: Introductionmentioning

confidence: 99%

A type II implementation-effectiveness hybrid quasi-experimental pilot study of a clinical intervention to re-engage people living with HIV into care, ‘Lost & Found’: an implementation science protocol

Cox

Linthwaite

Engler

et al. 2020

Pilot Feasibility Stud

View full text Add to dashboard Cite

Background: At the McGill University Health Centre (MUHC), 10% of patients living with HIV do not return for care annually. Currently, no formal system exists to re-engage out-of-care (OOC) patients. Lost & Found, developed using an implementation science approach, is an intervention to re-engage OOC patients. It is based on existing evidencebased interventions and will be adapted for use by nurses at the MUHC. The aims of this study are to simultaneously assess both implementation and effectiveness of Lost & Found in order to determine the viability of a future multisite stepped-wedge cluster randomised trial. Methods: Lost & Found consists of two core elements: identifying and contacting OOC patients. Based on formative work involving MUHC nurses, and the use of a combined implementation framework (enhanced Replicating Effective Programs, Tailored Implementation for Chronic Diseases, and Proctor et al.'s implementation outcomes), we will adapt the intervention to our clinic. Adaptations include the creation of an OOC risk prediction tool, an automated real-time OOC list, and prioritization of high-risk OOC patients for re-engagement. Delivery and ongoing adaptation of the intervention will follow a three-pronged implementation strategy consisting of (1) promoting adaptability; (2) planning, engaging, executing, evaluating, and reflecting cycles; and (3) internal facilitation. This 15-month quasi-experimental pilot study adopts a type II implementation-effectiveness hybrid design. To evaluate implementation, a convergent parallel mixed-methods approach will guide the mixing of qualitative and quantitative data at time points throughout the study. In addition, descriptive and pre-post analyses, for each of the implementation and sustainability phases, will inform evaluations of the cumulative effectiveness and sustainability of the Lost & Found intervention.

show abstract

Effectiveness and cost-effectiveness of a nurse-delivered intervention to improve adherence to treatment for HIV: a pragmatic, multicentre, open-label, randomised clinical trial

Abstract: Netherlands Organisation for Health Research and Development.

Cited by 96 publications

References 26 publications

Adherence to medication in adults with Cystic Fibrosis: An investigation using objective adherence data and the Theoretical Domains Framework

Adherence to medication in adults with Cystic Fibrosis: An investigation using objective adherence data and the Theoretical Domains Framework

The Cost-Effectiveness of Financial Incentives for Viral Suppression: HPTN 065 Study

A type II implementation-effectiveness hybrid quasi-experimental pilot study of a clinical intervention to re-engage people living with HIV into care, ‘Lost & Found’: an implementation science protocol

Contact Info

Product

Resources

About