January 30, 2013
University of Pennsylvania in Philadelphia researchers report that HIV-infected patients who participated in a year-long, personalized counseling program, Managed Problem Solving, were more likely to adhere to treatment and have undetectable viral loads than HIV-infected patients who did not participate in the program. The Managed Problem Solving program consists of 16 meetingsfour face-to-face sessions supplemented by monthly reminder phone calls. The program's aim is to help HIV-infected patients identify and resolve barriers to treatment adherence. According to Robert Gross, MD, HIV-infected patients might not stick with drug schedules because of low health literacy, lack of social support, substance abuse, depression, or the complexity of their daily drug regimen.
The study recruited 180 patients from academic specialty HIV clinics to participate in the Managed Problem Solving program. Most of the participants (85 percent) were black, and 60 percent were men. Twenty-six percent of participants indicated drug use, and 17 percent indicated "hazardous" alcohol use. Almost half of participants (40 percent) had no experience with HIV treatment.
Previous studies have established that interventions that improve adherence to HIV treatment are cost-effective if implementation of the intervention costs less than $1,000 annually; Gross asserted that the labor-intensive Managed Problem Solving program meets this standard. Program counselors must have a college degree and experience with patient care. The annual salary for each counselor was $50,000, but each counselor devoted only 15 percent of their total effort to following 20 study participants throughout the year. Expenses also included an annual $150 cost for pill-bottle monitors.
The full report, "Managed Problem Solving for Antiretroviral Therapy Adherence: A Randomized Trial," was published online in the Journal of American Medicine Association Internal Medicine (2013; doi: 10.1001/jamainternmed.2013.2152).