OUTPATIENT NURSE MANAGED HIV ADHERENCE TRIAL

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DESCRIPTION (Adapted from Applicant's Abstract): Highly active antiretroviral therapy (HAART) that includes a protease inhibitor has led to significant reductions in HIV-related morbidity and mortality. However, the challenge of adhering to HAART therapy is immense. This revised application proposes a randomized clinical trial to test a standardized HAART adherence intervention program, Client Adherence Profiling-Intervention Tailoring (CAP-IT), implemented by nurse case managers during regularly scheduled home visits, for clients (n=222) newly admitted in the AIDS Case Management Program, Office of AIDS, State of California. CAP-IT is an innovative, structured nursing assessment and care planning activity that allows a standardized assessment of client needs and tailored HAART intervention strategies. CAP-IT is significantly different from the current standard nursing case management practice. The study aims are: 1) To test if a standardized adherence intervention program, compared to standard care, results in improved HAART adherence rates; 2) To test if a standardized adherence intervention program, compared to standard care, impacts CD4 count, viral load, and HAART resistance; 3) To test if there is a relationship between adherence and CD4 count, viral load, and HAART resistance; 4) To test if a standardized adherence intervention program, compared to standard care, impacts clients' quality of life; and, 5) To test if a standardized adherence intervention program, compared to standard care, impacts health-related resource utilization. The review of the literature supports the significance of the issue of adherence to HAART therapy and the need for further research focused on the effectiveness of interventions aimed at improving adherence and subsequent health-related outcomes. Evidence is also provided to support the feasibility of utilizing nurse case managers to delivery a home care-based adherence intervention.