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University of Pennsylvania in
Philadelphia researchers report that HIV-infected patients who participated in
a year-long, personalized counseling program, Managed Problem Solving, were
more likely to adhere to treatment and have undetectable viral loads than
HIV-infected patients who did not participate in the program. The Managed
Problem Solving program consists of 16 meetings—four face-to-face sessions
supplemented by monthly reminder phone calls. The program’s aim is to help
HIV-infected patients identify and resolve barriers to treatment adherence.
According to Robert Gross, MD, HIV-infected patients might not stick with drug
schedules because of low health literacy, lack of social support, substance
abuse, depression, or the complexity of their daily drug regimen.
The study recruited 180 patients
from academic specialty HIV clinics to participate in the Managed Problem
Solving program. Most of the participants (85 percent) were black, and 60
percent were men. Twenty-six percent of participants indicated drug use, and 17
percent indicated “hazardous” alcohol use. Almost half of participants (40
percent) had no experience with HIV treatment.
Previous studies have established
that interventions that improve adherence to HIV treatment are cost-effective
if implementation of the intervention costs less than $1,000 annually; Gross
asserted that the labor-intensive Managed Problem Solving program meets this
standard. Program counselors must have a college degree and experience with
patient care. The annual salary for each counselor was $50,000, but each
counselor devoted only 15 percent of their total effort to following 20 study
participants throughout the year. Expenses also included an annual $150 cost
for pill-bottle monitors.
The full report, “Managed Problem
Solving for Antiretroviral Therapy Adherence: A Randomized Trial,” was
published online in the Journal of American Medicine Association Internal
Medicine (2013; doi: 10.1001/jamainternmed.2013.2152).
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
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