Barcelona 2013
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| Abstract #445 - Adherence | ||||
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Session: 13.1: Adherence (Parallel) on Monday @ 14.30-16.00 in Teatre Chaired by Imma Serra, Stuart Gibson Authors: Presenting Author: Dr Robert Remien - Columbia University and New York State Psychiatric Institute, United States |
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| Additional Authors: Dr. Jorge Galindo-Sainz, | ||||
| Aim: Masivukeni (?Lets Wake Up? in Xhosa) is an innovative multimedia-based, computer-driven, lay counselor delivered intervention designed to help people living with HIV in resource-limited settings achieve optimal adherence. Through engaging, multimedia activities key psychosocial and behavioral components of ART adherence are addressed (e.g., problem solving, treatment knowledge, treatment self-efficacy, and treatment support). Adapted from a couples-based intervention tested in the United States, Masivukeni was developed through community-based participatory research with United States and South African partners and informed by Ewart?s Social Action Theory. The goal of this pilot study was to examine adherence and key psychosocial outcomes for a small group of non-adherent HIV+ patients randomized to receive either Masivukeni or standard of care (SOC) counseling for ART defaulters in an HIV clinic in the Western Cape Region of South Africa. | ||||
| Method / Issue: Fifty-five HIV+ patients identified as non-adherent were randomized to receive either Masivukeni or SOC counseling sessions for ART defaulters. Patients were assessed across key domains related to Social Action Theory: self-regulation, social regulation, and contextual factors. Psychosocial variables measured included: adherence self-efficacy, attitudes towards disclosure, beliefs about medications, HIV/AIDS knowledge HIV treatment knowledge, perceived social stigma, medication social support, perceived availability of social support, social rejection, clinic-patient relationship, and psychological distress. Pharmacy refill data were available on a subset of 20 participants. Assessments occurred pre-randomization, post-intervention, and at one-month follow-up. GLM/GEE was used to compare groups on the psychosocial outcomes. | ||||
| Results / Comments: Of the 33 participants randomized to Masivukeni, 27 (82%) attended Session 1; 26 completed a post-intervention interview; and 23 completed all six intervention sessions. Of the 32 participants randomized to SOC, 28 (88%) completed the post-intervention assessment. Seventy-percent of participants were women; mean age was 38; 94% spoke Xhosa at home; 92% had less than a high school education; 83% were unemployed; and 49% had gone without food at least once in the past month. There were no significant differences between the SOC and Masivukeni groups on any of the psychosocial variables at baseline. Analyses revealed significantly more positive attitudes towards disclosure, significantly more medication social support, significantly less social rejection, and significantly better clinic-patient relationships among those in the Masivukeni arm at the one-month follow-up compared to those in the SOC arm. We also found a trend towards less perceived stigma among those in the MSV arm at follow-up than those in the SOC arm. Analysis of pharmacy pill count adherence rates revealed that Masivukeni participants improved by 10%, while SOC participants declined by 8%. | ||||
| Discussion: In this small pilot trial, comparisons between SOC and Masivukeni groups revealed several significant results and important trends on key domains theorized to be related to ART adherence. Furthermore, there was a trend towards more improved adherence among those who received Masivukeni sessions than those who received SOC sessions. Masivukeni shows promise to help promote theorized key psychosocial components to adherence. Further research is needed to replicate these findings in a larger sample. Masivukeni is currently undergoing a full-scale RCT in South Africa. | ||||
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