An adherence-enhancing program increases retention in care in the Swiss HIV Cohort. Open Forum Infectious Diseases
Kamal et al. tested a theory-based cognitive behavioral intervention to increase HIV treatment engagement and retention. The study hypothesis was that the interprofessional medication adherence program (IMAP) has the ability to increase retention in care by reinforcing pharmaceutical care as well as coordination of care between pharmacists, physicians, and nurses.
The authors retrospectively compared their intervention center (intervention group [IG]) with a standard of care center (control group [CG]) both participating in the Swiss HIV Cohort Study between 2004 and 2012. Endpoints were defined as >6-month and >12-month gaps in care for intervals of care longer than 6 and 12 months without any blood draw. Viral failure was defined as HIV-1 RNA ≥50 copies/ mL after 24+ weeks on antiretrovirals.
In the IMAP, medication adherence is monitored via electronic monitors (EM’s), fitted with a digital display showing the number of openings day by day to the patient; EM is combined with manual pill count. During motivational interviews (MIs), electronic adherence data, in the form of a chronology plot, is shown to the patient as feedback every 30 to 90 days depending on patients’ needs, and a report is sent to the physician after each interview to ensure continuity in care. All adherence moderating factors are discussed during the MI in a comprehensive approach. Patients are referred to social or psychological aid if needed.
The IG included 451 patients, CG 311. In the IG, 179 (40%) patients took part in the IMAP for a median of 27 months (interquartile range, 12–45). Gaps in care of ≥6 months were significantly more likely to happen in the CG versus IG (74.6% vs 57%, P < .001). The median time until the first treatment gap was longer in the IG vs CG (120 vs 84 weeks, P < .001). Gaps in care of ≥12 months evaluated in 709 (93%) patients were significantly more likely to occur in the CG compared with the IG (22.6% vs 12.5%, P < .001). The rate of viral failure was significantly lower in the IG (8.3% vs 15.1%, P = .003).
In conclusion, there is an ongoing need for evidence-based interventions to increase retention in care. This study showed the potential of a theory-based medication adherence program for reducing gaps in follow up over 6- and 12-month periods among adult PWH. The authors suggest adapting and implementing this intervention in other settings to verify its effectiveness in increasing retention in care.