Adherence counseling during HIV treatment greatly improves patient outcomes

Intensive adherence counseling around the time of HIV treatment initiation significantly reduces poor adherence and virologic treatment failure in sub-Saharan Africa, according to a recent study in PLoS Medicine by Dr. Michael Chung, assistant professor of Global Health at University of Washington, who works at the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya.

The study published March 1 also found that using an alarm device has no effect on adherence counseling.

The findings of this study define an adherence counseling protocol that is effective and highly relevant to other HIV clinics caring for large numbers of patients in sub-Saharan Africa. As poor adherence to HIV treatment can lead to drug resistance and inadequate treatment of HIV, it is necessary to identify adherence interventions that are inexpensive and proven to be effective in resource-limited settings. The study complements a recent study on cell-phone strategies to increase adherence to HIV treatment published in Lancet 2010, which Chung also contributed as a co-author.

Chung helped the Coptic Hospital in Kenya establish the Hope Clinic, a free HIV care and treatment clinic. In 2004, this relationship led to a collaboration between the University of Washington and the Coptic Mission to provide free HIV care and treatment to Kenyans with support from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). By 2010, more than 16,000 HIV-infected Kenyans have received medical treatment at the Coptic Hope Centers for Infectious Diseases.

In this recent study, the authors randomized 400 patients who were newly diagnosed with HIV and had never before taken antiretroviral therapy to receive adherence counseling alone; alarm device alone; both adherence counseling and alarm device together; and a control group that received neither adherence counseling nor alarm device.

Patients had baseline blood levels and then every six months for the duration of the study-18 months. After starting HIV treatment, patients returned to the study clinic every month with their pill bottles for the study pharmacist to count and recorded the number of pills remaining in the bottle.

Patients receiving adherence counseling were 29 percent less likely to experience poor adherence compared to those who received no counseling. Furthermore, those receiving intensive early adherence counseling were 59 percent less likely to experience viral failure. However, there was no significant difference in mortality or significant differences in CD4 counts at 18 months follow-up between those who received counseling and those who did not. There were also no significant differences in adherence, time to viral failure, mortality, or CD4 counts in patients who received alarm devices compared to those who did not.

The authors conclude: "As antiretroviral treatment clinics expand to meet an increasing demand for HIV care in sub-Saharan Africa, adherence counseling should be implemented to decrease the development of treatment failure and spread of resistant HIV."