August 24, 2005
U.S. scientists recently reported the results of a study conducted "to assess the efficacy of a couple-based intervention to improve medication-taking behavior in a clinic population with demonstrated adherence problems."
The SMART Couples Study, a randomized controlled trial, was conducted between August 2000 and January 2004 in two New York City HIV/AIDS outpatient clinics. The study included 215 heterosexual and homosexual HIV-serodiscordant couples in which the HIV-positive partner's medication adherence was less than 80 percent at baseline. Most couples were lower-income racial/ethnic minorities. Participants were randomly assigned to one of two conditions: usual care or a four-session, couple-focused adherence intervention.
The intervention included education about treatment and adherence, identifying adherence barriers, developing strategies for communication and problem solving, optimizing partner support, and building confidence. A Medication Event Monitoring System cap was used to assess adherence at week 8, two weeks after the intervention, compared with baseline.
According to R.H. Remien and colleagues at the New York State Psychiatry Institute and Hospital in New York City, "Intervention participants showed higher mean medication adherence at postintervention when compared with controls whether adherence was defined as proportion of prescribed doses (76 versus 60 percent) or doses taken within specified time parameters (58 versus 35 percent)."
Intervention participants were "significantly more likely" to achieve adherence levels of 80 percent or better compared with those in the usual care group. In most cases, however, this effect diminished over time, as seen at three- and six-month follow-up.
"The SMART Couples program significantly improved medication adherence over usual care, although the level of improved adherence, for many participants, was still suboptimal and the effect was attenuated over time."
The full report, "Couple-Focused Support to Improve HIV Medication Adherence: A Randomized Controlled Trial," was published in AIDS (2005;19(8):807-814).