Randomized clinical trial of HIV treatment adherence counseling interventions for people living with HIV and limited health literacy.
Randomized clinical trial of HIV treatment adherence counseling interventions for people living with HIV and limited health literacy.
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DOI：
10.1097/qai.0b013e318286ce49
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发表时间：
2013-05-01
期刊：
影响因子：
--
通讯作者：
Schinazi RF
中科院分区：
文献类型：
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作者：
Kalichman SC;Cherry C;Kalichman MO;Amaral C;White D;Grebler T;Eaton LA;Cruess D;Detorio MA;Caliendo AM;Schinazi RF
健康知识有限是艾滋病毒感染者坚持服药的一个已知障碍。迫切需要对这一弱势群体采取提高依从性的干预措施。这项研究测试了象形文字引导的坚持技能建设咨询干预有限识字的成年艾滋病毒感染者的有效性。男性和女性艾滋病毒感染者和接受抗逆转录病毒治疗（ART，N=446）谁得分低于90%正确的功能性健康素养测试分为边缘和较低的识字组，并随机分配到三个坚持咨询条件之一：（a）象形文字指导的坚持咨询，（B）标准坚持咨询，或（c）一般健康改善咨询。参与者在干预后随访9个月，以未公布的药丸计数依从性和血浆病毒载量作为主要终点。初步分析证明了试验的完整性，超过90%的参与者被保留。广义估计方程之间的显着相互作用的咨询条件和参与者的健康素养水平的结果。与一般健康咨询相比，在象形图指导和标准咨询条件下具有边缘健康素养的参与者表现出更大的依从性和不可检测的HIV病毒载量。相反，相反的假设，参与者的健康素养技能较低的一般健康改善咨询表现出更大的坚持相比，两个坚持咨询条件。边缘识字技能的患者受益于坚持咨询，无论象形剪裁和识字技能较低的患者可能需要更密集或提供者指导的干预。
Limited health literacy is a known barrier to medication adherence among people living with HIV. Adherence improvement interventions are urgently needed for this vulnerable population. This study tested the efficacy of a pictograph-guided adherence skills building counseling intervention for limited literacy adults living with HIV. Men and women living with HIV and receiving antiretroviral therapy (ART, N=446) who scored below 90% correct on a test of functional health literacy were partitioned into marginal and lower literacy groups and randomly allocated to one of three adherence-counseling conditions: (a) pictograph-guided adherence counseling, (b) standard adherence counseling, or (c) general health improvement counseling. Participants were followed for 9-months post-intervention with unannounced pill count adherence and blood plasma viral load as primary endpoints. Preliminary analyses demonstrated the integrity of the trial and more than 90% of participants were retained. Generalized estimating equations showed significant interactions between counseling conditions and levels of participant health literacy across outcomes. Participants with marginal health literacy in the pictograph-guided and standard-counseling conditions demonstrated greater adherence and undetectable HIV viral loads compared to general health counseling. In contrast and contrary to hypotheses, participants with lower health literacy skills in the general health improvement counseling demonstrated greater adherence compared to the two adherence counseling conditions. Patients with marginal literacy skills benefit from adherence counseling regardless of pictographic tailoring and patients with lower literacy skills may require more intensive or provider directed interventions.