March 1, 2011
Intensive counseling on adhering to HIV treatment improves patient outcomes
In sub-Saharan Africa, newly diagnosed HIV patients who get intensive counseling on sticking with their treatment regimen are more likely to take their medications and less likely to fail treatment.
This is the finding of a study published March 1 in PLOS Medicine. Dr. Michael Chung, assistant professor of global health, led the research. He works at the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya.
The study also found that using an alarm device has no effect on adherence.
This study created a method for counseling patients on the importance of following their treatment protocol. The method may be effective and highly relevant to other HIV clinics caring for large numbers of patients in sub-Saharan Africa.
Not following the prescribed plan for taking HIV medications can lead to drug resistant strains of the virus and inadequate treatment of the viral infection.
Researchers working in poor countries with few medical resources wanted identify inexpensive interventions that are effective in helping patients comply with treatment.
The latest findings complement another study on cell-phone strategies to increase adherence to HIV treatment. The findings were reported last year in The Lancet. Chung contributed as a co-author.
Chung helped the Coptic Hospital in Kenya establish the Hope Clinic, a free HIV care and treatment facility. In 2004, this relationship led to a collaboration between the University of Washington and the Coptic Mission to provide free HIV care and treatment to Kenyans. The effort received support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). By 2010, more than 16,000 HIV-infected Kenyans have received medical treatment at the Coptic Hope Centers for Infectious Diseases.
In this recent study, the authors randomized 400 patients who were newly diagnosed with HIV and had never before taken antiretroviral therapy. Some were given adherence counseling alone, others an alarm device alone; and the rest received both both adherence counseling and an alarm device. A control group received neither adherence counseling nor an alarm device.
Before treatment began, patients had a baseline blood test. The test was repeated every six months for the duration of the 18-month study. After starting HIV treatment, patients returned to the study clinic every month with their pill bottles. The study pharmacist counted and recorded the number of pills remaining in the bottle.
Patients received counseling were 29 percent less likely to adhere poorly to their treatment plan, compared to those who received no counseling. Furthermore, those receiving early, intensive counseling were 59 percent less likely to have viral failure — which means the virus is no longer adequately suppressed.
However, there was no significant difference in mortality or significant differences in CD4 counts — a measure of disease progression — at 18 months follow-up between those who received counseling and those who did not. There were also no significant differences in adherence, time to viral failure, mortality, or CD4 counts in patients who received alarm devices compared to those who did not.
The authors conclude: “As antiretroviral treatment clinics expand to meet an increasing demand for HIV care in sub-Saharan Africa, adherence counseling should be implemented to decrease the development of treatment failure and spread of resistant HIV.”
News reporters who would like more information on this study can contact Bobbi Nodell, communications officer for UW Global Health, at 206-543-8309.