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Problem-solving intervention helps patients adhere to HIV medicines

Helping patients adhere to new HIV treatment regimens using a problem-solving intervention is more successful than usual pharmacist care, a US study suggests (JAMA Internal Medicine, online 28 January 2013).

Consultant HIV pharmacist and HIV Pharmacy Association representative Heather Leake Date said the UK already takes a multidisciplinary approach to HIV treatment, with crucial pharmacist input, that results in better virological success rates than were seen in the study. “Nonetheless, the [study] intervention could be a useful addition to our toolkit, especially in particularly ‘hard-to-reach’ patients,” she told PJ Online.

The investigator-blinded trial involved adults with HIV-1 who were starting or changing their treatment. Patients were randomly allocated to receive either usual care, which included meeting with a pharmacist to learn about their regimen and, if desired, the provision of pill organisers, or the Managed Problem Solving (MAPS) intervention (see Panel). A total of 124 patients completed the one-year follow-up — falling short of the target sample size of 180.

Costs outweighed by savings through increased adherence

Patients who received the MAPS intervention (n=58) were 78 per cent more likely to have better adherence than those who received usual care (n=66) (odds ratio 1.78, 95 per cent confidence interval 1.07–2.96). They were also 48 per cent more likely to have an undetectable viral load at any follow-up point (OR 1.48 CI 0.94–2.31).

Implementation of the MAPS intervention should be considered wherever resources are available, say the researchers. They note that the approach is resource-intensive, but suggest the costs are outweighed by savings made through increased adherence.

An accompanying commentary (ibid) says: “While this intervention achieved a durable behavioral and biologic effect, calling every HIV-infected person on treatment every month of their life may not be feasible or necessary.” The authors suggest that the MAPS intervention should be offered in connection with lapses in adherence.

The problem-solving intervention

Patients allocated to the Managed Problem Solving intervention group received four face-to-face and 12 telephone consultations over three months with a specially trained member of staff, followed by monthly follow-up calls.

During the consultations, staff used a five-step process to identify barriers to adherence, find solutions and monitor outcomes, repeating the process as necessary.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2013.11116638

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