Interventions to Enhance HAART Adherence: Review of an Emerging Field .

Jane M. Simoni, Pam A. Frick, & Karina L. Walters. Department of Psychology, University of Washington, Box 351525, Seattle, WA 98105-1525 (USA).

Background: Initial optimism regarding the efficacy of HAART has dissipated in the face of the onerous challenges of maintaining the nearly perfect and probably indefinite adherence to precise dosing schedules and exacting dietary adjustments that successful therapy requires. The seriousness and urgency of the problems associated with adherence to antiretroviral medications has sparked increasing attention to this issue; however, scant empirical research on adherence interventions has been published. Material and Methods: After considering various definitions of adherence as well as its correlates, we present a review of adherence intervention research from published reports as well as federally funded studies in progress. Results: Current research on correlates of adherence as well as medication taking in other diseases supports the efficacy of such strategies as assessing and addressing individual patient needs and barriers; nurturing the therapeutic alliance as well as other sources of social support; employing comprehensive and individualized cognitive, behavioral, and affective strategies; and continuously monitoring adherence with a variety of assessment methods. Empirical research specifically focusing on interventions to bolster HAART adherence, however, is in a nascent stage of development, providing few data by which to definitively guide clinical practice. Results of five RCTs conducted with adequate methodological rigor suggest some promising yet preliminary effects of a pharmacist-led individualized intervention, a cognitive and behavioral educational intervention based on self-efficacy theory, and cue-dosing when combined with monetary reinforcement.  However, even these encouraging findings are marred by methodological limitations. Finally, a review of ongoing federally funded research revealed 39 adherence intervention projects assessing a diversity of adherence strategies. Conclusion: We conclude with guidelines for best practices as well as recommendations for future research.