Individualised Motivational Counselling to Enhance Adherence to Antiretroviral Therapy is not Superior to Didactic Counselling in South African Patients: Findings of the CAPRISA 058 Randomised Controlled Trial

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• 作者：Francois van Loggerenberg ; Alison D. Grant ; Kogieleum Naidoo…
• 关键词：Antiretroviral therapy adherence ; IMB ; Motivational interviewing ; HIV
• 刊名：AIDS and Behavior
• 出版年：2015
• 出版时间：January 2015
• 年：2015
• 卷：19
• 期：1
• 页码：145-156
• 全文大小：422 KB
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• 作者单位：Francois van Loggerenberg (1) (2) (3)
  Alison D. Grant (2)
  Kogieleum Naidoo (1)
  Marita Murrman (4)
  Santhanalakshmi Gengiah (1)
  Tanuja N. Gengiah (1)
  Katherine Fielding (5)
  Salim S. Abdool Karim (1) (4)
  
  1. CAPRISA, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
  2. Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
  3. The Global Health Network, Centre for Tropical Medicine, University of Oxford, NDM Research Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK
  4. Mailman School of Public Health, Columbia University, New York, NY, USA
  5. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Public Health
  Health Psychology
  Infectious Diseases
  
• 出版者：Springer Netherlands
• ISSN：1573-3254

文摘

Concerns that standard didactic adherence counselling may be inadequate to maximise antiretroviral therapy (ART) adherence led us to evaluate more intensive individualised motivational adherence counselling. We randomised 297 HIV-positive ART-na?ve patients in Durban, South Africa, to receive either didactic counselling, prior to ART initiation (n?=?150), or an intensive motivational adherence intervention after initiating ART (n?=?147). Study arms were similar for age (mean 35.8?years), sex (43.1?% male), CD4+?cell count (median 121.5 cells/μl) and viral load (median 119,000 copies/ml). Virologic suppression at 9?months was achieved in 89.8?% of didactic and 87.9?% of motivational counselling participants (risk ratio [RR] 0.98, 95?% confidence interval [CI] 0.90-.07, p?=?0.62). 82.9?% of didactic and 79.5?% of motivational counselling participants achieved?>95?% adherence by pill count at 6?months (RR 0.96, 95?% CI 0.85-.09, p?=?0.51). Participants receiving intensive motivational counselling did not achieve higher treatment adherence or virological suppression than those receiving routinely provided didactic adherence counselling. These data are reassuring that less resource intensive didactic counselling was adequate for excellent treatment outcomes in this setting.