Stigma management intervention to improve antiretroviral therapy adherence: Phase-I test of concept trial, Cape Town South Africa

ABSTRACT

Combination antiretroviral therapy (cART) has transformed HIV infection from a universally fatal disease to a medically manageable chronic illness. We conducted a Phase-I test of concept intervention trial to examine feasibility and potential efficacy of behavioural self-regulation counselling designed to improve care retention and cART adherence. The intervention was culturally adapted from client-centered evidence–based interventions that are grounded in behavioural self-regulation theory and available in the US. The intervention adaptation included enhancements to directly address HIV stigma and alcohol-related sources of nonadherence. Fifty patients receiving cART in Cape Town, South Africa were randomised to receive either: (a) five weekly cellphone-delivered sessions of stigma and alcohol-enhanced behavioural self-regulation counselling or (b) a contact matched control condition. Participants were baseline assessed and followed for two weeks post-intervention, with 94% of participants retained throughout the study. Participants receiving the intervention significantly improved cART adherence from baseline-to-follow up and improvement was significantly greater than the control condition. Behaviours related to stigma and alcohol use that impede cART adherence were significantly reduced, and there was uptake of adherence improvement strategies. The current study supports the potential efficacy of relatively brief behavioural self-regulation counselling delivered by cellphone in a context of differentiated care in South Africa.

KEYWORDS:

• HIV treatment adherence
• HIV stigma
• health care
• health improvement
• mobile health

Acknowledgements

This research was supported by Research Development funds from the Office of the Vice President for Research at the University of Connecticut and grants R01-AA023727 from the National Institute of Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Child Health and Development (NICHD) R01-HD074560.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This research was supported by Research Development funds from the Office of the Vice President for Research at the University of Connecticut and grants R01-AA023727 from the National Institute of Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Child Health and Development (NICHD) R01-HD074560.