Improving Coping Skills for Self-management of Treatment Side Effects Can Reduce Antiretroviral Medication Nonadherence
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ORIGINAL ARTICLE
Improving Coping Skills for Self-management of Treatment Side Effects Can Reduce Antiretroviral Medication Nonadherence among People Living with HIV Mallory O. Johnson, Ph.D. & Samantha E. Dilworth, M.A. & Jonelle M. Taylor, B.A. & Torsten B. Neilands, Ph.D.
Published online: 5 October 2010 # The Author(s) 2010. This article is published with open access at Springerlink.com
Abstract Background Human immunodeficiency virus (HIV) treatment side effects have a deleterious impact on treatment adherence, which is necessary to optimize treatment outcomes including morbidity and mortality. Purpose To examine the effect of the Balance Project intervention, a five-session, individually delivered HIV treatment side effects coping skills intervention on antiretroviral medication adherence. Methods HIV+ men and women (N=249) on antiretroviral therapy (ART) with self-reported high levels of ART side effect distress were randomized to intervention or treatment as usual. The primary outcome was self-reported ART adherence as measured by a combined 3-day and 30-day adherence assessment. Results Intent-to-treat analyses revealed a significant difference in rates of nonadherence between intervention and control participants across the follow-up time points such that those in the intervention condition were less likely to report nonadherence. Secondary analyses revealed that intervention participants were more likely to seek information about side effects and social support in efforts to cope with side effects. Conclusions Interventions focusing on skills related to ART side-effects management show promise for improving ART adherence among persons experiencing high levels of perceived ART side effects.
M. O. Johnson (*) : S. E. Dilworth : J. M. Taylor : T. B. Neilands Center for AIDS Prevention Studies, University of California San Francisco, 50 Beale Street, Suite 1300, San Francisco, CA 94105, USA e-mail: [email protected]
Keywords Side effects . Antiretroviral therapy . Adherence . Compliance . RCT
Introduction While the life-extending benefits of antiretroviral therapies (ART) for human immunodeficiency virus (HIV) are welldocumented, aversive side effects accompany drug benefit [1]. Side effects are predictable, undesirable, and dose-related pharmacologic effects that occur within therapeutic dose ranges. The most common side effects from ART are gastrointestinal problems such as diarrhea, nausea and vomiting, and dermatological problems such as rashes. Additional “unseen” negative effects that become apparent over time include cardiac and liver problems, bone loss, and increased triglyceride levels [2]. Side effects are often cited when evaluating the impact of ART on the HIV treatment arena [3–5]. While newer ART drugs have fewer side effects, the goal of a completely side effect-free, clinically effective regimen has yet to be realized. As such, HIV-positive patients will have to face the realities of side effects in the foreseeable future. Perceived or anticipated side effects from ART have been l
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