The purpose of this study is to evaluate the effectiveness of a computer-assisted,
self-administered adherence program for patients on complicated anti-HIV drug regimens.
Highly active antiretroviral therapy (HAART) for HIV produces dramatic reductions in
morbidity and mortality for many patients who maintain a high level of adherence to their
medications. However, 20% to 33% of HIV infected patients will miss at least one of their
medication doses over a one to three day period. Patient self-report is the most practical
method for assessing adherence, but it may produce unreliable and invalid results unless
optimally performed. A computer-assisted, self-administered adherence program could improve
HIV infected patients’ adherence behaviors by accurately and efficiently assessing their
medication adherence, delivering an adherence intervention to patients, and producing
adherence reports for providers. By providing a neutral and seemingly private interview,
computer programs may increase patient disclosure of non-adherence. This study will
evaluate the efficacy of a computer-assisted, self-administered adherence program in
reducing regimen misunderstandings and enhancing patient adherence.
Participants in this study will be recruited from within the Positive Health Program at San
Francisco General Hospital. Patients will be randomly assigned to a Control or Intervention
Group. Control Group participants will complete an audio computer-assisted self-interview
(A-CASI) assessing their understanding of their medication regimen and adherence.
Intervention Group participants will complete the adherence A-CASI and will receive a brief
computer-delivered intervention consisting of a graphical depiction of their correct regimen
and strategies for improving adherence. Study investigators will forward a
computer-generated adherence report, which summarizes their adherence and suggests
appropriate interventions, to the Intervention Group’s health care providers. All
participants will be assessed at least three times over a 6-month period: study entry, Month
3, and Month 6.
- Receiving HIV care at San Francisco General Hospital’s Positive Health Program
- Three or more antiretroviral medications
- HIV-1 viral load > 500 copies/ml
- At least one previous salvage regimen
- Ability to read English at 8th grade level
- Visual impairments that prevent patient from reading text on a computer screen
- Obvious cognitive impairment