Antiretroviral (ARV) medications are highly effective in controlling HIV - provided that patients adhere to the medications appropriately. However adherence problems are very common, and evidence is clear that providers have great difficulty 'diagnosing'poor adherence accurately. If healthcare providers can identify patients with adherence problems, they can intervene to help patients overcome these problems and take their medications as prescribed. But doing this well requires a systems approach, especialy since providers have limited time. Patient-focused clinical informatics to collect more accurate adherence information from patients by system reducing social desirability and recall biases may help promote accurate diagnoses of poor ARV adherence. They may also help providers recognize factors that may contribute to poor adherence, such as medication errors, unrecognized depression, and illicit drug use. This proposed interdisciplinary, multi-methods project uses HIV/Adhere, a prototyped, piloted audio-and computer-assisted self-interview (aCASI) tool that interfaces with electronic medical record systems (EMR), with the goal of improving identification of and care for ARV adherence problems. This project will address the following: 1. Determine whether use of HIV/Adhere aCASI enhanced adherence assessment in HIV clinical care, when compared to usual clinical care, leads to: (1a) better clinical detection of variations in adherence to HIV ARV medications, (1b) better clinical detection of patient medication errors, (1c) better patient receipt of counseling about ARV use and adherence, and (1d) better patient adherence to ARV medications. 2. Determine whether analysis of provider-patient interactions using a quantitative method for audio-coding identifies more adherence-related dialogue in HIV/Adhere aCASI clinical encounters compared to usual clinical care, and whether adherence-related dialogue is related to better ARV adherence. 3. Use qualitative, rapid ethnographic assessment methods including focused field observations, rapid interviews, and semi-structured interviews to evaluate organizational culture, patient expectation, and patient-provider relationship issues in real-world implementation of HIV/Adhere. We will conduct a randomized, controlled practical clinical trial to address the aims above, and will combine this quantitative study with qualitative and specialized audio-tape coding methods. Medication adherence will be objectively measured using electronic drug monitoring (EDM). The research team has extensive previous experience in the fields of HIV/AIDS, medication adherence, and implementation research, sound methodological expertise;and excellent organizational support for conducting innovative informatics-based quality enhancement implementation research.
|McInnes, D Keith; Hardy, Hélène; Goetz, Matthew B et al. (2013) Development and field testing of an HIV medication touch screen computer patient adherence tool with telephone-based, targeted adherence counseling. J Int Assoc Provid AIDS Care 12:397-406|