Cue-dose training with monetary reinforcement - Pilot study of an antiretroviral adherence intervention

OBJECTIVE: To assess the feasibility and efficacy of two interventions for improving adherence to antiretroviral therapy regimens in HIV-infected subj ects compared with a control intervention. DESIGN: Randomized, controlled, pilot study. SETTING: Department of Veterans Affairs HIV clinic and community-based HIV clinical trials site. PARTICIPANTS: Fifty-five HIV-infected subjects on stable antiretroviral the rapy regimens. Subjects were predominantly male (89%) and African American (69%), and had histories of heroin or cocaine use (80%). INTERVENTIONS: Four weekly sessions of either nondirective inquiries about adherence (control group, C], cue-dose training, which consisted of the use of personalized cues for remembering particular dose times, and feedback a bout medication taking using Medication Event Monitoring System (MEMS) pill bottle caps, which record time of bottle opening (CI) group), or cue-dose training combined with cash reinforcement for correctly timed bottle openin g (CD+CR). MEASUREMENTS: Opening of the pill bottle within 2 hours before or after a p redetermined time was measured by MEMS. RESULTS: Adherence to the medication as documented by MEMS was significantl y enhanced during the 4-week training period in the CD+CR group, but not in the CD group, compared with the control group. Improvement was also seen i n adherence to antiretroviral drugs that were not the object of training an d reinforcement. Eight weeks after training and reinforcement were disconti nued, adherence in the cash-reinforced group returned to near-baseline leve ls. CONCLUSIONS: Cue-dose training with cash reinforcement led to transient imp rovement in adherence to antiretroviral therapy in a population including m ostly African Americans and subjects with histories of drug abuse. However, we were not able to detect any sustained improvement beyond the active tra ining period, and questions concerning the timing and duration of such an i ntervention require further study. Randomized, controlled clinical studies with objective measures of adherence can be conducted in HIV-infected subje cts and should be employed for further evaluation of this and other adheren ce interventions.