Developing an adherence support intervention for patients on antiretroviral therapy in the context of the recent IDU-driven HIV/AIDS epidemic in Estonia

Abstract

There is limited data on and experience with interventions for antiretroviral therapy (ART) adherence support for patients on ART in Eastern Europe. We sought to identify a feasible adherence support intervention for delivery amongst HIV-positive adults receiving care in Estonia, where the HIV/AIDS epidemic has been mainly concentrated among injection drug users (IDUs). Our application of intervention mapping (IM) strategies used existing literature, formative research and multidisciplinary team input to produce a brief clinic-based intervention entitled the Situated Optimal Adherence Intervention Estonia (sOAI Estonia) which uses both Next-Step Counseling (NSC) and Information–Motivation–Behavioral Skills (IMB) Model approach to facilitate integration of ART into the context and demands of daily life. We present the intervention development process, the resulting sOAI Estonia approach, and describe a randomized controlled trial (RCT) which is under way to evaluate the intervention (results due in spring 2013).

Keywords:

• ART
• HAART
• adherence
• intervention

Acknowledgements

We gratefully acknowledge the contribution of all our study participants and the sOAI Estonia Study Team (Dr Jelena Šmidt, Dr Svetlana Semjonova, Dr Juta Kogan and Kristiina Šreiner, Anne Junolainen from the department of infectious diseases in Ida-Viru Central Hospital, Estonia), and Anna Markina and Mait Raag from the University of Tartu, Estonia.

This research was supported by Target Financing of Estonian Ministry of Education and Research (grant SF0180060s09); REACH-study grant from Tibotec Pharmaceuticals; New York State International Training and Research Program grant D43-TW000233, from the National Institutes of Health/Fogarty International Center and the National Institute on Drug Abuse; and grant R01 DA029888 from the National Institutes of Health/the National Institute on Drug Abuse. Dr Anjali Sharma is supported by the Robert Wood Johnson Foundation Physician Faculty Scholars Program.