Educational interventions improve adherence to HAART

Buenos Aires: Poor adherence to anti-HIV therapy, considered the most important cause of treatment failure, can be improved through the use of structured educational programmes delivered by health care professionals. Three programmes, including one evaluated within the context of a randomised, controlled trial, were described at the First International AIDS Society Conference on HIV Pathogenesis and Treatment in Buenos Aires today.

Ciel Bleu is an educational toolkit developed by a French company called Bleu Citron. The kit is used in face-to-face settings to teach patients about HIV pathogenesis, disease progression, the rationale for anti-HIV therapy, and the importance of adherence. The kit has been evaluated within a prospective, comparative study which randomised 365 HAART recipients to take part in a Treatment Education Programme (TEP) or to a control arm which received standard follow-up (Goujard).

The TEP included four face-to-face sessions of one hour each which were conducted by a treatment educator, who was either a doctor or a nurse. Along with the educational component, patients received a beeper pillbox, and a number of devices to aid treatment scheduling.

Every six months, study participants completed adherence, quality of life, and knowledge and autonomy questionnaires. Adherence was measured using a one week retrospective indicator. Adherence levels were stratified by the study investigators.

At entry to the study, average age amongst participants was 40.5 years. Average time from diagnosis was 7.1 years, and duration of treatment 4.0 years. Average CD4 was 439 cells and viral load 2.42 log. Fifty seven percent of the cohort had viral load below 200 copies. Eighty five percent were receiving PI-based HAART, and 27% NNRTI-based HAART. At baseline, adherence levels were comparable across the two arms, with 46% belonging to the upper level adherence strata.

Adherence levels were attributed a mean score. Over six months follow-up, this mean score improved in the TEP group, indicating that participants had improved their adherence level, whilst the mean score in the control arm fell. The difference between the two arms was significant.

Response to treatment, however, reflected in viral load and CD4 count results did not appreciably change in either group. There is a range of possible explanations for this apparent ‘disconnect’, one being the relatively short follow-up period, another that the improvement in adherence was not adequate to drive an improvement in biological markers. Alternatively, it’s possible that some participants may already have experienced treatment failure on entry to the study – improvements in adherence would not be expected to result in improved treatment response if resistance to the regimen taken had already emerged.