International conference on hiv treatment adherence-

Optimal adherence to antiretroviral therapy ART is central to achieving viral suppression and positive health outcomes in HIV-infected individuals. Virally suppressed individuals can also reduce the risk of HIV transmission to uninfected partners. However, achieving optimal ART adherence can be challenging, especially over the long term. To augment the literature, we present a review of ART adherence interventions from — present. We included peer-reviewed journals as well as abstracts from two key conferences.

International conference on hiv treatment adherence

International conference on hiv treatment adherence

Moderator: Lisa Metsch. CD4 counts sig. August 21, Lucas GM. BHCs, usually masters level social workers, served as International conference on hiv treatment adherence health specialists on HIV medical care specialty teams, focused on improving retention, viral suppression, and reducing behavioral health issues. Staff thought patients would prefer intervention. Acknowledgements Drs. Health Divas: a culturally relevant intervention to improve engagement in care among transgender women living with HIV. Adherence is a dynamic Ihternational [ 61 ]. Remien declare that they have no conflict of interest Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal Trans a performed by any of the authors.

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Issues to consider as we shape research, practice, and policy agendas are reviewed. Editions Jun Frequency Annual. Table 1. Join Internationnal. Behavioral interventions to promote adherence have been considered in several comprehensive reviews. International conference on hiv treatment adherence 10 Research Literature on ART Adherence Interventions Behavioral interventions to promote adherence have been considered in several comprehensive reviews. Simple, effective interventions are key to improving adherence in marginalized populations. This is contrasted to study adherende use, which requires persistence through the full length of the trial to determine safety and efficacy. They stressed the need for intensive, continuous, coordinated, and nurturing case management services, with screening and treatment for mental health problems and substance abuse.

The conference Track Chairs are Thomas P.

  • The target audience for this conference includes physicians, nurses and nurse-practitioners, pharmacists, psychologists, behavioral scientists, social scientists, public health specialists, epidemiologists, social workers, case managers, peer educators and navigators, and community health workers working in the field of HIV medicine.
  • This annual series of conferences feature the presentation and discussion of HIV treatment and biomedical prevention adherence research, as well as current behavioral and clinical perspectives in practicum, within the context of achieving an optimized continuum of HIV care and prevention.
  • The success of antiretroviral therapy ART for HIV infection, though widespread and resounding, has been limited by inadequate adherence to its unforgiving regimens, especially over the long term.
  • The conference will feature a keynote address, memorial lecture, and memorial colloquium, as well as breakfast workshops, plenary addresses, panel discussions, oral abstract sessions, and a poster session.

The conference Track Chairs are Thomas P. Following are conference presentations. The conference organizers request that any use of these presentations should include citations to both their presenting authors and relevant conference information e. Simoni Michael Stirratt. Giordano Michael Mugavero Jane M. Simoni Patrick Sullivan. What Is It Not? Presenter: Thomas Odeny. GARY S. Choice: The Secret to Adolescent Persistence? Presenter: Laura Myers.

Rivet Amico. Nadia Nguyen. How Do We Get There? Presenter: Millicent Atujuna. Requires free Acrobat Reader Plugin Software. June 17 - 19, View Archives. July 21, September 21 - 22, May 3 - 4, September 8 - 11, Our Conferences Miami.

Mexico City.

Assessing antiretroviral adherence via electronic drug monitoring and self-report: An examination of key methodological issues. Please review our privacy policy. Our Sponsors. Contingency management interventions for HIV-related behaviors. Our contention is that adherence to experimental study drug and PrEP an antiretroviral medication with known HIV prevention benefits will not be identical or interchangeable, although their degree of separation is difficult to determine relying on currently available literature. Health Psychol.

International conference on hiv treatment adherence

International conference on hiv treatment adherence

International conference on hiv treatment adherence

International conference on hiv treatment adherence

International conference on hiv treatment adherence

International conference on hiv treatment adherence. Medical Education

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Optimal adherence to antiretroviral therapy ART is central to achieving viral suppression and positive health outcomes in HIV-infected individuals. Virally suppressed individuals can also reduce the risk of HIV transmission to uninfected partners. However, achieving optimal ART adherence can be challenging, especially over the long term. To augment the literature, we present a review of ART adherence interventions from — present. We included peer-reviewed journals as well as abstracts from two key conferences.

Non-adherence to medications is a limiting factor in the successful treatment of numerous health conditions, including hypertension, diabetes, tuberculosis, and mental illness. Relatively short lapses in medication adherence can lead to the development of viral resistance, compromising the treatment options available to the patient and ultimately the health of the person living with HIV [ 2 — 4 ].

Non-adherence to ART is believed to be the strongest predictor of poor clinical outcomes, including morbidity and mortality for people living with HIV [ 5 — 8 ]. Since the development of effective combination therapy to treat HIV in , there has been a great deal of attention devoted to establishing optimal adherence for people initiating ART and for those already on treatments who demonstrate sub-optimal adherence.

Thus, efforts to initiate early treatment for those individuals that test positive are critical to preventing HIV among their sexual partners. To achieve substantial protection, individuals must either have complete viral suppression, always practice safer sex, or preferably both.

Viral suppression is attainable through complying with medication dosing. Strong evidence for the effectiveness of PrEP, to prevent HIV acquisition among those vulnerable to acquiring HIV, through the use of topical PrEP agents in the form of microbicide gels [ 15 ] and oral medication [ 16 , 17 ] has been reported. Among the trials that failed, it was shown that adherence was very poor [ 18 ]. Ultimately it is adherence to these biomedical interventions that predicts desired outcomes, namely the prevention of HIV acquisition.

Thus, despite increased emphasis on developing new pharmacological interventions [ 19 ], like PrEP, in the arsenal to combat the spread of HIV, adherence continues to be a lynchpin in providing long-term viral suppression for those already infected and adherence to PrEP offers a viable form of protection for those uninfected and at highest risk for acquiring HIV. Also, adherence to PrEP in clinical trials has been wrought with challenges, leading researchers and health care providers to wonder about the potential impact of intermittent or inconsistent PrEP use on healthy uninfected individuals [ 15 — 18 ].

Increasingly, fiscal resources for health care, in general, and HIV care, specifically, are being limited, therefore it is crucial to prioritize those interventions that have been shown to improve adherence. They reported that while there was strong evidence that all of these strategies can significantly increase ART adherence in the short-term, several studies failed to produce significant effects, Combination interventions i.

The first and only Clinical Guidelines for improving entry into and retention in care and ART adherence for persons with HIV was published in [ 31 ]. A panel of 31 medical and behavioral experts reviewed studies that met criteria in accordance with Institute of Medicine Standards for Developing Trustworthy Clinical Practice Guidelines. A total of 39 recommendations were made in 4 domains: 1. Given the prominent role of adherence to ART in preventing HIV transmission, researchers and clinicians must continue to remain current on recent advances in adherence research.

This is especially important for providers serving populations with disproportionately high HIV incidence rates, such as young men who have sex with men MSM , and African American men in the US [ 45 ].

Previous reviews on ART adherence interventions only included studies that were published through Studies describing this aim were selected for review if they were published over the past year between and , were published in peer-reviewed journals, described outcome data i. The literature search was conducted via Medline searchable through PubMed , and PsycInfo and SocIndex databases, two online databases in the social and health sciences.

Search term categories for the first search included: adherence to anti-retrovirals, compliance with anti-retrovirals, adherence to PrEP, adherence interventions, HIV medication adherence, HIV treatment adherence. This resulted in a total of ten studies that met the criteria. Similar to our review of the published literature we searched for poster abstracts that described empirical studies of behavioral interventions to promote adherence to ART, cART, HAART or to PrEP medication regimens, however our search included pilot studies as well as studies that reported preliminary findings.

We also included two recent studies from our group. The interventions reviewed ranged from individual counseling to text messaging to computerized self-administered approaches among various populations, such as youth [ 32 , 33 ], newly released inmates [ 34 ], transgender women [ 35 ], and adults with low health literacy [ 36 ]. Among those interventions for adults, some had samples that were predominantly African American [ 32 ], except for two that were specifically developed for Hispanic and Latino individuals [ 37 , 38 ].

Among those integrating technological components, one intervention used a self-administered computer program [ 39 ], three used text messages [ 40 — 42 ], one was a self-administered ART adherence breathalyzer [ 43 ], and another a mobile application [ 44 ] for use with smartphones.

Among the interventions reviewed for youth, two included families. Multisystemic therapy MST was compared to usual care plus Motivational Interviewing MI to improve ART adherence [ 33 ] among predominantly perinatally infected youth between 9—17 years of age. While participants randomized to MST showed significantly greater decreases in viral load VL at 9 months post-baseline compared to the MI group, there were no differences between groups on CD4 and self-report adherence, though CD4 and adherence improved significantly from treatment initiation to study end.

This was a small study with 19 youth randomized to receive the cell phone support or standard care. Facilitator initiated support calls consisted of discussing whether the youth had taken his or her medication, as well as encouraging youth to express any issues related to taking ART, problem-solving, and assisting youth in accessing clinic and community resources.

Intervention arm improvements in adherence were observed in week 24 and sustained through week Over the past several years, great interest has emerged in leveraging technology, such as portable computers, smartphones and tablets, and web-based applications, for the promotion of health behaviors [ 68 — 74 ].

Technology represents an important area of clinical practice and research, as new innovations can increase capacity of resource limited healthcare settings and enhance health care delivery, as well as promote positive health outcomes. Among the 7 interventions we identified using technology-based startegies, three examined text messaging based ART adherence interventions. Tailored text messaging [ 40 ] was shown to be acceptable to adult HIV patients. Viral load significantly decreased and CD4 counts significantly increased among all study participants, while self-reported adherence increased only among the non-adherent patients.

Participants received text messages based on self-reported medication adherence e. He scores! Great job! However, the study lasted only 4 months with no long-term follow up. While findings appear promising, this was a small study with no control group, and previous research has shown only limited efficacy for text messaging based interventions [ 28 ].

Other text messaging based interventions included bi-directional text messages that included reminders, problem solving, and supportive texts [ 41 ] and text messaging for substance using HIV-infected adults [ 42 ]. Bidirectional text messaging was found to be feasible given the high rate of cell phone use in the clinic site; ART adherence was not directly measured [ 41 ].

Substance using patients in another text messaging intervention showed significantly better self-reported and pharmacy refill estimated ART adherence at 3-month follow-up compared to the treatment as usual group [ 42 ]. However, there were no differences in ART adherence between intervention and control groups at 6-month follow-up [ 42 ]. Two studies examined novel technology-based interventions.

While an easy to use, immediate result measure of ART adherence could offer patients and providers an important tool; further research on the SMART adherence system is needed.

All nine adult participants thought the app would be useful for adherence. Two studies examined multimedia computer-based interventions; one was self-administered [ 39 ], the other was lay counselor delivered [ 50 ]. A pilot test of the self-administered eLifeSteps intervention compared to treatment as usual showed that participants in the intervention condition reported higher self-efficacy to adhere to ART than those in the control arm, though there were no differences between groups on self-reported ART adherence rates.

The eLifeSteps program is a single session, self-paced intervention based on Life Steps [ 51 ], which includes videos and a quiz that lasts between 33 to 90 minutes. The six-session Masivukeni intervention uses videos and interactive activities to convey complex information about HIV and HIV treatment, as well as to systematically guide counselors through intervention content. Nine interventions were based on different counseling modalities e.

While self-reported adherence was significantly associated with viral load, no differences between groups were observed. A nurse initiated phone support intervention implemented within the AIDS Clinical Trails Group ACTG multicenter trial found no differences in self-reported adherence rates between those randomized to receive the standard adherence phone calls as part of ACTG and those in the site nurse initiated and enhanced support phone call intervention [ 50 ].

Participants in the site nurse initiated intervention received calls at 1 to 3 days post ART initiation and then again at weeks 1, 2, 3, 6, 10, 14, 18, 22 and 26 and every 8 weeks thereafter for up to weeks. Among the counseling-based interventions focused on a specific vulnerable population e. Those with marginal health literacy showed greater adherence as measured via unannounced telephone-based pill counts and lower viral load after receiving the pictograph or standard counseling compared to those who received the general health counseling [ 36 ].

There were no differences in adherence between pictograph and standard counseling participants. Those with lower health literacy showed greater adherence after receiving general health counseling than those who received either pictograph or standard counseling.

Two studies examined culturally adapted ART interventions for Hispanic populations. One study found that Hispanic adults randomized to standard care plus culturally sensitive educational information counseling showed significantly higher CD4 counts and HIV knowledge at 6 months post-baseline than those in the standard care only adherence counseling [ 37 ]. Adherence was not directly measured in this study.

One study [ 35 ] developed a peer led counseling intervention for transgender women and provided women with individual counseling covering medication information, support, and skills building for adherence. All 12 participants reported high satisfaction with the intervention.

Partners e. Finally, the use of Behavioral Health Consultants BHCs embedded in 9 HIV clinics who provide adherence counseling resulted in improvement in retention in care and ART use, based on receipt of prescription and viral load, at one year follow-up [ 58 ]. BHCs, usually masters level social workers, served as behavioral health specialists on HIV medical care specialty teams, focused on improving retention, viral suppression, and reducing behavioral health issues.

There was no comparison group in this study. We identified one recently published abstract that examined an adherence intervention for PreP and delivered by counselors and pharamcists [ 59 ]. Staff thought patients would prefer the counseling intervention that they were trained in. We contend that considerable work, particularly longitudinal research, is needed to address the challenge of life long adherence to treatment.

Corresponding with other health conditions, there is a plethora of HIV-specific research documenting a wide array of adherence barriers, not limited to but including individual level factors e. Since there is such a wide array of adherence barriers and facilitators that can change over time, it has been challenging to develop and test interventions that are implemented with consistency for all study participants, but that still address the varying specific needs of the individual participants.

Since the field is advancing rapidly, it is useful to keep abreast of the latest developments. Of the studies identified in this review, some describe full-scale randomized controlled trials, while others are descriptions of smaller pilot and feasibility studies. The majority of interventions continue to rely on patient counseling, whether in individual or group settings.

There is a growing emphasis on interventions targeting young people, which is appropriate given the disproportionately higher risk for HIV and need for adherence programs with this population. We also are seeing a growing emphasis on the use of technological supports for intervention delivery, especially with the use of text-messages. Finally, only a few of the studies involved adherence interventions to support PrEP, since PrEP has only been recently approved for implementation in community settings.

While we also would advocate for the development and testing of systemic interventions to improve ART adherence, including linkage and retention in care, we must continue to promote and support adherence behaviors of individuals who are receiving treatment and the providers providing the treatment and care [ 60 ]. Further, the needs of individuals vary from person to person and change over time within any individual. Adherence is a dynamic phenomenon [ 61 ]. This makes it very challenging to develop and test adherence interventions that are targeted at a population of people, since the specific barriers and facilitators of adherence are likely to differ from person to person receiving the intervention and at any given moment in time.

The field is in need of newer methodologies that would allow greater tailoring of intervention activities to meet the range of needs for trial participants. Further, when standard care is variable across studies it is difficult to interpret findings and to generalize to other contexts, especially when standard care is not well-defined in study descriptions [ 63 ].

De Bruin and colleagues [ 62 ] provide an excellent analysis demonstrating how standard of care comparisons effect trial outcomes and make helpful recommendations for the adherence research field. While the utilization of technology is exciting and shows promise for efficiency and effectiveness, we would argue that there will continue to be a need for human interaction to optimize adherence over time, particularly for the long-term.

Also, we believe that provider-patient communication and support will always be fundamental to good practice and adherence outcomes and advocate for the use of technological supports i. There are a number of limitations to our review.

International conference on hiv treatment adherence

International conference on hiv treatment adherence