Randomized Factorial Trial of Phone-Delivered Support Counseling and Daily Text Message Reminders for HIV Treatment Adherence
Randomized Factorial Trial of Phone-Delivered Support Counseling and Daily Text Message Reminders for HIV Treatment Adherence
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DOI：
10.1097/qai.0000000000001020
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发表时间：
2016-09-01
影响因子：
3.6
通讯作者：
Schinazi, Raymond F.
中科院分区：
文献类型：
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作者：
Kalichman, Seth C.;Kalichman, Moira O.;Schinazi, Raymond F.
背景：HIV感染在临床上可以通过抗逆转录病毒治疗(ART)来控制，但必须持续坚持。提高和维持抗逆转录病毒药物治疗依从性的经济有效的干预措施仍然是受到不依从性挑战的人群的当务之急。这项研究的目的是测试(1)简短的电话递送的自我调节咨询和(2)每日电话递送的短信药物提醒对HIV依从性和HIV病毒抑制的独立和交互效果。方法：随机2(5次电话递送的依从性支持咨询与接触匹配的对照)×2(每日ART短信提醒与不提醒)试验，主要终点为每月电话未宣布的药片计数-确定的ART依从性和HIV病毒抑制监测超过12个月。结果：自我调节依从性咨询在达到90%的ART方面有显著改善在前6个月的随访中，依从性相对于对照组。在85%和95%的依从率下进行的敏感性分析中，效果仍然显著。咨询在抑制艾滋病毒方面也显示出不大但显著的效果。日常短信提醒没有主要影响或交互作用，有一些证据表明坚持自我效能有不良影响。结论：通过电话提供的短暂坚持支持咨询在坚持ART和抑制HIV方面显示出临床上有意义的改善，尽管这些好处并不是在所有患者或长期内都明显存在。如果ART要实现其潜在的临床和公共卫生益处，推进依从性干预措施以及维持依从性收益的有效手段仍然是优先事项。
Background:HIV infection is clinically managed with antiretroviral therapy (ART), but only with sustained adherence. Cost-efficient interventions to improve and sustain ART adherence remain a pressing priority for populations challenged by nonadherence. The aim of this study was to test the independent and interactive effects of (1) brief phone-delivered self-regulation counseling and (2) daily phone-delivered text message medication reminders on HIV adherence and HIV viral suppression.Method:A randomized 2 (5 sessions of phone-delivered adherence support counseling vs. contact-matched control) x 2 (daily ART text reminders vs. no reminders) trial with primary end points of monthly phone-based unannounced pill count-determined ART adherence and HIV viral suppression monitored over 12 months.Results:Self-regulation adherence counseling demonstrated significant improvements in achieving 90% ART adherence relative to the control group over the first 6 months of follow-up. Effects remained significant in sensitivity analyses conducted at 85% and 95% adherence. Counseling also demonstrated modest but significant effects on HIV suppression. There were no main effects or interactions for daily text message reminders, with some evidence for adverse effects on adherence self-efficacy.Conclusions:Brief adherence support counseling delivered by phone demonstrates clinically meaningful improvements in ART adherence and HIV suppression, although these benefits were not evidenced in all patients or in the long-term. Advancing adherence interventions along with an effective means for sustaining gains in adherence remain priorities if ART is to achieve its potential clinical and public health benefits.