Impact of adherence counseling dose on antiretroviral adherence and HIV viral load among HIV-infected methadone maintained drug users

Abstract

Adherence counseling can improve antiretroviral adherence and related health outcomes in HIV-infected individuals. However, little is known about how much counseling is necessary to achieve clinically significant effects. We investigated antiretroviral adherence and HIV viral load relative to the number of hours of adherence counseling received by 60 HIV-infected drug users participating in a trial of directly observed antiretroviral therapy delivered in methadone clinics. Our adherence counseling intervention combined motivational interviewing and cognitive-behavioral counseling, was designed to include six 30 minute individual counseling sessions with unlimited “booster” sessions, and was offered to all participants in the parent trial. We found that, among those who participated in adherence counseling, dose of counseling had a significant positive relationship with antiretroviral adherence measured after the conclusion of counseling. Specifically, a liner mixed-effects model revealed that each additional hour of counseling was significantly associated with a 20% increase in post-counseling adherence. However, the number of cumulative adherence counseling hours was not significantly associated with HIV viral load, also measured after the conclusion of counseling. Our findings suggest that more intensive adherence counseling interventions may have a greater impact on antiretroviral adherence than less intensive interventions; however, it remains unknown how much counseling is required to impact HIV viral load.

Keywords:

• HIV
• adherence
• counseling
• dose
• drug users

Acknowledgements

This research was supported by Grants R01DA015302 and K23DA025049 from the National Institute on Drug Abuse, Grant 13-1624225 from the New York State Department of Health AIDS Institute, and a Center for AIDS Research Grant P30AI51519 from the National Institute of Allergy and Infectious Diseases. The authors thank Terri Febbrarro, Mark Flores, Ken Harris, Wendy Hunt, Angela Jeffers, Daniel Kaswan, Marc King, Lisa Moseley, Rosie Rodriguez, and Edwin Roman for coordinating and providing the adherence counseling. The authors thank Metta Cantlo, Amanda Carter, Hillel Cohen, Elise Duggan, Uri Goldberg, Harris Goldstein, Joseph Hecht, Laxmi Modali, Jennifer Mouriz, Francesca Parker, Megha Ramaswamy, and Maite Villanueva for assistance with protocol development, pharmacy coordination, data collection and management, and laboratory analyses. This study was dependent on the cooperation of the medical providers, nurses, and patients at the Albert Einstein College of Medicine and Montefiore Medical Center Division of Substance Abuse. We also thank the staff members at Melrose Pharmacy, Bendiner & Schlesinger, Inc., and Bio-Reference laboratories, Inc.