Journal
HEALTH PSYCHOLOGY
Volume 26, Issue 4, Pages 488-495Publisher
AMER PSYCHOLOGICAL ASSOC
DOI: 10.1037/0278-6133.26.4.488
Keywords
HIV/AIDS; HAART; adherence; social support; depression
Categories
Funding
- NIAID NIH HHS [P30 AI027757] Funding Source: Medline
- NIMH NIH HHS [R01 MH058986, F31 MH071179, 1 F31 MH71179, 1 R01 MH58986] Funding Source: Medline
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Objective: To determine the efficacy of a peer-led social support intervention involving support groups and telephone contacts compared with standard clinical care to enhance antiretroviral medication adherence. Design: Randomized controlled trial with follow-up. Participants were 136 HIV-positive indigent mainly African American and Puerto Rican men and women recruited from an outpatient clinic in the Bronx, New York. The 3-month intervention was delivered by other HIV-positive clinic patients trained in addressing barriers to adherence and sensitively providing appraisal, spiritual, emotional, and informational adherence-related social support. Main outcome measures: Medical chart-abstracted HIV-1 RNA viral load, antiretroviral adherence according to electronic drug monitoring and participant self-report, and social support and depressive symptomatology. All assessments conducted at baseline, 3 months, and 6 months. Results: Intent-to-treat and as-treated analyses indicated no between-conditions intervention effects on the primary outcome of HIV- I RNA viral load or any of the secondary outcomes at immediate postintervention or follow-up. Post hoe analyses within the intervention condition indicated greater intervention exposure was associated with higher self-reported adherence, higher social support, and lower depressive symptomatology at follow-up, even after controlling for baseline adherence. Conclusion: Null findings, consistent with the limited literature on efficacious highly active antiretroviral therapy (HAART) adherence interventions, may be due to insufficient exposure to the intervention, its low intensity, or the nature of the sample-a heterogeneous HAART-experienced group of patients with high levels of substance use and multiple other competing stressors. Overall, findings highlight the need for more comprehensive and intensive efforts to battle nonadherence.
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