Improving Coping Skills for Self-management of Treatment Side Effects Can Reduce Antiretroviral Medication Nonadherence among People Living with HIV

Abstract

BackgroundHuman immunodeficiency virus (HIV) treatment side effects have a deleterious impact on treatment adherence, which is necessary to optimize treatment outcomes including morbidity and mortality.PurposeTo examine the effect of the Balance Project intervention, a five-session, individually delivered HIV treatment side effects coping skills intervention on antiretroviral medication adherence.MethodsHIV+ men and women (N = 249) on antiretroviral therapy (ART) with self-reported high levels of ART side effect distress were randomized to intervention or treatment as usual. The primary outcome was self-reported ART adherence as measured by a combined 3-day and 30-day adherence assessment.ResultsIntent-to-treat analyses revealed a significant difference in rates of nonadherence between intervention and control participants across the follow-up time points such that those in the intervention condition were less likely to report nonadherence. Secondary analyses revealed that intervention participants were more likely to seek information about side effects and social support in efforts to cope with side effects.ConclusionsInterventions focusing on skills related to ART side-effects management show promise for improving ART adherence among persons experiencing high levels of perceived ART side effects.

Interventions for Enhancing Adherence to Antiretroviral Therapy (ART): A Systematic Review of High Quality Studies

“…Based on the factors responsible for poor adherence, the interventions were categorized as patient related (n = 31), 36 37,62,63,69,83 social and economic factors (n = 1), 77 and condition related (n = 1). 44 The interventions in thirty-nine of these studies targeted only the patient; …”

“…62 One of 11 (9.1%) complex interventions improved adherence and clinical outcomes. 73 None of the interventions for condition-related 44 and socioeconomic difficulties 77 was successful for both adherence and clinical outcomes.…”

A Review of the Use of Complementary and Alternative Medicine and HIV: Issues for Patient Care

“…These include abnormal psychology, mood and related disorders, personal and social uncertainty, identity issues, stigma, social isolation, poor quality of life, and unemployment, 5 and a range of side effects from ART such as gastrointestinal and dermatological effects, cardiac and liver problems, and bone loss. 8 The impact of HIV on physical and emotional health may be worse than for many other chronic diseases. 9 CAM is still often used to address these complex health and social issues associated with living with HIV/AIDS, 10 including stress reduction, relieving sideeffects and symptoms, and boosting the immune system.…”

Stress management interventions for HIV-infected individuals: review of recent intervention approaches and directions for future research

“…64 A second study sought to improve stress management skills and enhance PLWHA's ability to cope with HAART medication side effects. 86 Individuals who completed the five individual stress management sessions were less likely to report nonadherence and were more likely to seek out additional information about medication side effects and utilize social support to cope with HAART side effects. 86 A third study compared a 10-week CBSM intervention supplemented with four brief medication adherence training sessions delivered by a pharmacist to a medication adherence training only group.…”

“…86 Individuals who completed the five individual stress management sessions were less likely to report nonadherence and were more likely to seek out additional information about medication side effects and utilize social support to cope with HAART side effects. 86 A third study compared a 10-week CBSM intervention supplemented with four brief medication adherence training sessions delivered by a pharmacist to a medication adherence training only group. 87 There were no differences in viral load between the two groups; however, PLWHA in the intervention condition who had a detectable viral load at baseline had decreased viral load relative to the medication adherence training only group.…”