Barcelona 2013
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| Abstract #477 - Adherence | ||||
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Session: 13.2: Adherence (Parallel) on Monday @ 14.30-16.00 in Teatre Chaired by Imma Serra, Stuart Gibson Authors: Presenting Author: Dr Graham Frize - Imperial College NHS Trust, United Kingdom |
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| Additional Authors: Dr. Jorge Galindo-Sainz, | ||||
| Aim: Evidence suggests when antiretroviral (ART) adherence is not established in childhood it reflects a range of self-management difficulties which impede intervention to establish adherence in later adolescence. 20% of our transitioning cohort fell into this pattern. Consultation with clients suggested the potential importance of financial incentive (FI). This fits Behaviour Change theory which requires identification of concrete rewards for changing contingencies. Motivational Interviewing (MI) also has some (equivocal) established evidence in this area. An Incentive Scheme (IS) combining FI and MI intervention was developed with viral load (VL) related goals. | ||||
| Method / Issue: Young people (16-24y) with PaHIV, low CD4 count and significant adherence problems were eligible. IS involved MI at 2 weekly follow up until a drop and then VL<50 was achieved. Receiving FI was contingent on reaching each goal in the series and attending for MI. Further goals involved sustaining VL<50 for increasing periods. Importance, confidence, adherence and stage of change was recorded at each visit, also identification of obstacles and potential solutions. Outcome was measured (VL and CD4 count) at exit from IS. The max total FI was £200/patient (£25/£50 for specific goals). Exit interviews gathered additional qualitative data. | ||||
| Results / Comments: 11 enrolled, 1 declined. Median age 19y (range 16-23), 8 female. 9/11 reached VL<50 and 5/11 sustained to the IS endpoint (6 months VL<50). IS time range 3-20 months, MI range 2-13 sessions, VL<50 time range 0-13 months (mean 10.2 for completers, 1.3 for non-completers), mean CD4 change 193 for completers, 23 for non-completers. There was a significant relationship between the number of MI sessions and success/failure of IS (p=.001), months of VL<50 (p=.001) and CD4 increment (p=.026). These data and qualitative interviews suggest that the mediating factor in success is engagement via reward, rather than reward for adherence directly. | ||||
| Discussion: Following this novel intervention, 46% of this highly challenging cohort achieved sustained virological suppression as a result of behavioural changes. Rewards appeared to encourage attendance. This in turn allowed psychological intervention to identify emotional and logistical solutions for this vulnerable group. The nature of the intervention needs further tailoring in line with behaviour change theory and further directions will be outlined. | ||||
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