Telephone support to improve antiretroviral medication adherence: A multisite, randomized controlled trial

Nancy R. Reynolds, Marcia A. Testa, Max Su, Margaret A. Chesney, Judith L. Neidig, Ian Frank, Scott Smith, Jeannette Ickovics, Gregory K. Robbins

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To determine whether proactive telephone support improves adherence to antiretroviral therapy (ART) and clinical outcomes when compared to standard care. METHODS: A multisite, randomized controlled trial (RCT) was conducted with 109 ART-naive subjects coenrolled in AIDS Clinical Trials Group (ACTG) 384. Subjects received standard clinic-based patient education (SC) or SC plus structured proactive telephone calls. The customized calls were conducted from a central site over 16 weeks by trained registered nurses. Outcome measures (collected over 64 weeks) included an ACTG adherence questionnaire and 384 study endpoints. RESULTS: For the primary endpoint, self-reported adherence, a significantly better overall treatment effect was observed in the telephone group (P = 0.023). In a post hoc analysis, composite adherence scores, taken as the first 2 factor scores from a principal components analysis, also found significant intervention benefit (P = 0.023 and 0.019 respectively). For the 384 primary study endpoint, time to regimen failure, the Kaplan-Meier survival curve for the telephone group remained above the SC group at weeks 20 to 64; a Cox proportional hazard model that controlled for baseline RNA stratification, CD4, gender, age, race/ethnicity, and randomized ART treatment arm suggested the telephone group tended to have a lower risk for failure (hazard ratio = 0.68; 95% confidence interval: 0.38 to 1.23). CONCLUSIONS: Findings indicate that customized, proactive telephone calls have good potential to improve long-term adherence behavior and clinical outcomes.

Original languageEnglish (US)
Pages (from-to)62-68
Number of pages7
JournalJournal of Acquired Immune Deficiency Syndromes
Volume47
Issue number1
DOIs
StatePublished - Jan 2008
Externally publishedYes

Keywords

  • Adherence
  • HIV
  • Phone intervention
  • Randomized controlled trial

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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