An Audio Music Self-Management Adherence Program to Improve ART Adherence

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DESCRIPTION (provided by applicant): HIV disease self-management is complicated by the need for exceedingly high levels of adherence to therapy and the ability to deal with the short and long term antiretroviral (ARV) related symptoms and side- effects. Strategies to enhance self-management skills and ART adherence have been evaluated to be moderately successful, but because of the added time, cost and personnel associated with some of these strategies, sustainability can be problematic, particularly in resource-limited settings. This application, in response to PA-07-340, proposes to develop and evaluate the feasibility and effectiveness of an easy to administer, educationally sound, portable music-enhanced audio self-management adherence program in improving ARV adherence and ARV-related symptom management. This approach will employ self- administered modules set to words and music that are designed to enhance patients' knowledge and self- efficacy in ARV self-management and adherence and medication-related symptom management; the modules will be accompanied by a reference manual. Content will emphasize the importance of adherence and will include adherence and problem solving strategies and suggestions for recognizing and managing ARV-related symptoms and side effects. Building on the known capacity of music to enhance listening appeal, motivation, learning, and recall of information, the modules will consist of songs and spoken words set to music. These modules, programmed into MP3 players, will be introduced and demonstrated to participants during two initial clinic visits, and each participant will receive his/her own pre-programmed MP3 player containing the entire 70 minute program and reference manual for use at home. An 800 number will be established for participants to call with questions. The intervention will be pilot tested in a sample of 72 HIV+ men and women who will be starting ART for the first time. The intervention will be compared (2:1 allocation) to the usual care (at least 2 visits with a trained ART nurse educator) at the study site. This approach is innovative, relatively inexpensive, practical, portable, and sustainable even in the most basic clinical setting. It could supplement and sustain the efforts of clinical staff and enhance comprehension in low or non-literate populations. There are four aims. 1) To develop a music-enhanced audio self-management adherence program that will be portable and accompanied by a user-friendly reference manual. 2) To gather formative information to enable further refinement of the program and research methods and procedures in order to conduct rigorous testing in a controlled clinical trial in the future. 3)To conduct a preliminary evaluation of the program designed to assess the impact (at 12 weeks) when compared to the usual care on the outcomes of adherence, therapeutic plasma ARV trough concentrations, viral load, CD4 counts, symptoms, and quality of life (QoL). 4)To examine the effects of the program on the mediators of self-efficacy, outcome expectancy, and personal goal setting. PUBLIC HEALTH RELEVANCE: We propose to develop and pilot test an audio music enhanced self-management adherence program that is downloadable to an MP3 player and has an accompanying manual. The portable, user friendly program is designed to educate and motivate HIV+ persons to adhere to their medications and manage medication related symptoms and may be particularly useful in persons with low literacy. If successful, the resultant higher levels of adherence will reduce viral load, thus reducing infectiousness, promoting health, and increasing quality of life.