Sustained Benefit From a Long-Term Antiretroviral Adherence Intervention

Mannheimer, Sharon; Morse, Edward; Matts, John P.; Andrews, Laurie; Child, Carroll; Schmetter, Barry; Friedland, Gerald

doi:10.1097/01.qai.0000245887.58886.ac

Cited by 99 publications

(93 citation statements)

References 34 publications

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“…Results of these prior studies are inconclusive. For example, Mannheimer and colleagues (18) found that patients assigned to a medication manager-who was often a research nurse-had a higher mean increase in CD4 count by an average of 22.4 at the end of 36 months, which is very consistent with our findings. Viral load differences were not statistically significant in their study.…”

Section: Discussionsupporting

confidence: 82%

A Randomized Trial of a Nursing Intervention for HIV Disease Management Among Persons With Serious Mental Illness

Blank¹,

Hanrahan²,

Fishbein³

et al. 2011

Psychiatric Services

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Objective-The heightened risk of persons with serious mental illness to contract and transmit HIV is recognized as a public health problem. Persons with HIV and mental illness may be at risk for poor treatment adherence, development of treatment-resistant virus, and worse outcomes. The objective of this study was to test the effectiveness of a community-based advanced practice nurse (APN) intervention (PATH, Preventing AIDS Through Health) to promote adherence to HIV and psychiatric treatment regimens.Methods-Community-dwelling HIV-positive participants with co-occurring serious mental illnesses (N=238) were recruited from community HIV provider agencies from 2004 to 2008 to participate in the randomized controlled trial. Participants in the intervention group (N=128) were assigned an APN who provided community-based care management at a minimum of one visit per week and coordinated clients' medical and mental health care for one year. Viral load and CD4 cell count were evaluated at baseline and 12 months.Results-Longitudinal models for continuous log viral load showed that compared with the control group, the intervention group exhibited a significantly greater reduction in log viral load at 12 months (d=−.361 log 10 copies per milliliter, p<.001). Differences in CD4 counts from baseline to 12 months were not statistically significant. DisclosuresThe authors report no competing interests. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptConclusions-This project demonstrated the effectiveness of community-based APNs in delivering a tailored intervention to improve outcomes of individuals with HIV and co-occurring serious mental illnesses. Persons with these co-occurring conditions can be successfully treated; with appropriate supportive services, their viral loads can be reduced.Persons with serious mental illnesses are at increased risk for contracting and transmitting HIV and have poor adherence to medication regimens. Estimates of the prevalence of HIV among persons with mental illnesses vary widely and range from 4% to 23%, compared to . 4%-.6% in the general population (1,2). Although already high, such estimates still may be underestimated and signal a hidden epidemic. A number of recent studies have drawn attention to the issue of undetected cases of HIV in inpatient psychiatric populations that are missed even by care providers (3,4).Early detection and treatment of HIV reduces the risk of its transmission and secondary infections, as well as treatment costs. Yet, the mentally ill population with HIV is one of the most difficult populations to treat because of cognitive dysfunction and poor adherence (5).Effective treatment of persons with HIV and comorbid mental illness is important from an individual clinical perspective as well as from a public health perspective. Persons with cooccurring HIV and mental illness are known to have higher rates of substance abuse and dependence as well as sexual risk behaviors (6). Finally, nonadherence to highly active ant...

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Section: Discussionsupporting

confidence: 82%

A Randomized Trial of a Nursing Intervention for HIV Disease Management Among Persons With Serious Mental Illness

Blank¹,

Hanrahan²,

Fishbein³

et al. 2011

Psychiatric Services

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“…Studies demonstrated that HIV-infected patients who received EI had obtained significant improvement in adherence [20][21][22][23][24]. Our study results also show similar positive significant association of greater than 95% of adherence outcomes to HAART in ICG patients (67.5%, p<0.001) after having received EIs on adherence counseling in comparison with SCG.…”

Section: Discussionsupporting

confidence: 78%

Evaluating the Impact of Educational Interventions on Use of Highly Active Antiretroviral Therapy and Adherence Behavior in Indian Human Immunodeficiency Virus Positive Patients: Prospective Randomized Controlled Study

et al. 2013

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“…For example, given that forgetting to take ART has been reported to be one of the most commonly stated adherence barriers, [12][13][14][15][16] many studies have examined the use of reminder devices in improving adherence. [17][18][19][20] However, most have not revealed clinically significant changes in adherence. Studies have reported other adherence barriers, including feeling depressed or overwhelmed, fear of disclosure, sleeping through a dose, substance use, regimen complexity, not having medication, change in daily routine, and not wanting to be reminded of HIV infection.…”

Section: Introductionmentioning

confidence: 99%

Barriers to Antiretroviral Therapy Adherence and Plasma HIV RNA Suppression Among AIDS Clinical Trials Group Study Participants

Saberi

Neilands

Vittinghoff

et al. 2015

AIDS Patient Care and STDs

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Sustained Benefit From a Long-Term Antiretroviral Adherence Intervention

Abstract: This large randomized clinical trial demonstrated that interpersonal structured adherence support was associated with improved long-term medication adherence and virologic and immunologic HIV outcomes.

Cited by 99 publications

References 34 publications

A Randomized Trial of a Nursing Intervention for HIV Disease Management Among Persons With Serious Mental Illness

A Randomized Trial of a Nursing Intervention for HIV Disease Management Among Persons With Serious Mental Illness

Evaluating the Impact of Educational Interventions on Use of Highly Active Antiretroviral Therapy and Adherence Behavior in Indian Human Immunodeficiency Virus Positive Patients: Prospective Randomized Controlled Study

Barriers to Antiretroviral Therapy Adherence and Plasma HIV RNA Suppression Among AIDS Clinical Trials Group Study Participants

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