학술논문
An Adherence-Enhancing Program Increases Retention in Care in the Swiss HIV Cohort
MAJOR ARTICLE
MAJOR ARTICLE
Document Type
Academic Journal
Author
Source
Open Forum Infectious Diseases. September 2020, Vol. 7 Issue 9
Subject
Language
English
ISSN
2328-8957
Abstract
Due to the success of combined antiretroviral therapy (cART), human immunodeficiency virus (HIV) has become a chronic illness that can be managed successfully [1], but it requires people with HIV [...]
Background. This study tested a theory-based adherence-enhancing intervention: the 'Interprofessional Medication Adherence Program'| (IMAP) to increase human immunodeficiency virus (HIV) retention in care. Methods. We retrospectively compared our 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. Inverse probability of treatment weights was used to adjust for differences between patients at the 2 centers. Viral failure was defined as ribonucleic acid [greater than or equal to] 50 copies/ mL after 24+ weeks on antiretrovirals. Results. 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 [greater than or equal to] 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 [greater than or equal to] 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). Conclusions. This study, in a real-world setting, shows the effectiveness of the IMAP to reduce 6- and 12-month gaps in follow up among people with HIV. These results should be confirmed by studies in other settings. Keywords. adherence intervention; antiretrovirals; HIV; interprofessionality; medication retention in care.
Background. This study tested a theory-based adherence-enhancing intervention: the 'Interprofessional Medication Adherence Program'| (IMAP) to increase human immunodeficiency virus (HIV) retention in care. Methods. We retrospectively compared our 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. Inverse probability of treatment weights was used to adjust for differences between patients at the 2 centers. Viral failure was defined as ribonucleic acid [greater than or equal to] 50 copies/ mL after 24+ weeks on antiretrovirals. Results. 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 [greater than or equal to] 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 [greater than or equal to] 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). Conclusions. This study, in a real-world setting, shows the effectiveness of the IMAP to reduce 6- and 12-month gaps in follow up among people with HIV. These results should be confirmed by studies in other settings. Keywords. adherence intervention; antiretrovirals; HIV; interprofessionality; medication retention in care.