Thirteen years into the era of highly active antiretroviral therapy (ART), medication adherence continues to be a serious barrier to effective treatment. While poor medication adherence adversely affects the outcomes of medical care in all chronic conditions, its impact is particularly devastating in HIV disease, leading to the gradual depletion of immune function, which can eventually result in death. Few interventions to improve patient adherence have focused on primary HIV care physicians. There is an urgent need to fill this gap. HIV providers are the ones who start, stop, and change ART;and the health care system currently pays for frequent physician visits. Because of this, small improvements in HIV providers'skills can have a large effect. Our long term goal is to develop, test, and disseminate effective, evidence-based HIV provider training programs that focus on improving patients'medication adherence. The overall objective of this R34 is to develop and test the feasibility, acceptability, and preliminary efficacy of an intensive physician training intervention based on principles of Motivational Interviewing (MI). Our central hypothesis is that HIV providers are knowledgeable and motivated about the importance of ART adherence for their patients with HIV, but lack the skills necessary to accomplish this counseling in the course of busy office practice. Our own and others'research has shown that physicians tend to talk little about medication adherence, that less than 10% of that talk can be categorized as problem solving in nature, and that physicians tend to lecture or give directives rather than listening and trying to understand patients'perspectives, obstacles and goals. We will pursue the following specific aims: (1) develop an intensive skills development intervention, based on principles of motivational interviewing, to train HIV providers to more effectively provide treatment adherence counseling, (2) conduct a pilot study comparing a 1-day training session (brief intervention) with a 1-day training session plus ongoing feedback (intensive intervention), and (3) evaluate the acceptability and feasibility of the pilot study. We will conduct our study at the Johns Hopkins HIV/AIDS clinic in Baltimore, MD, a region that has been greatly affected by the HIV/AIDS epidemic.
In Aim 1, we will conduct focus groups of HIV patients and providers, consult with experts, and review our own audio recordings of actual patient-provider communication regarding ART medication adherence. To accomplish Aim 2, we will randomize 10 HIV providers to the brief or intensive intervention arm, and measure baseline (pre) and follow-up (post) communication behaviors in actual patient encounters.
In Aim 3, we will assess provider response to the intervention components.

Public Health Relevance

In this application, we will design and evaluate the feasibility, acceptability and preliminary efficacy of a communication skills training program aimed at HIV providers focused on counseling regarding antiretroviral (ART) medication adherence. This is important because a substantial proportion of HIV-infected patients do not take medications, and HIV providers do not have the skills to counsel effectively about this issue.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Planning Grant (R34)
Project #
5R34MH089279-02
Application #
8128466
Study Section
Special Emphasis Panel (ZMH1-ERB-E (09))
Program Officer
Stirratt, Michael J
Project Start
2010-08-13
Project End
2013-04-30
Budget Start
2011-05-01
Budget End
2013-04-30
Support Year
2
Fiscal Year
2011
Total Cost
$342,738
Indirect Cost
Name
Johns Hopkins University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Laws, Michael Barton; Rose, Gary S; Beach, Mary Catherine et al. (2015) Patient-provider concordance with behavioral change goals drives measures of motivational interviewing consistency. Patient Educ Couns 98:728-33
Laws, M Barton; Lee, Yoojin; Rogers, William H et al. (2014) Provider-patient communication about adherence to anti-retroviral regimens differs by patient race and ethnicity. AIDS Behav 18:1279-87
Laws, M Barton; Beach, Mary Catherine; Lee, Yoojin et al. (2013) Provider-patient adherence dialogue in HIV care: results of a multisite study. AIDS Behav 17:148-59
Hsu, Ian; Saha, Somnath; Korthuis, Phillip Todd et al. (2012) Providing support to patients in emotional encounters: a new perspective on missed empathic opportunities. Patient Educ Couns 88:436-42
Korthuis, P Todd; Saha, Somnath; Chander, Geetanjali et al. (2011) Substance use and the quality of patient-provider communication in HIV clinics. AIDS Behav 15:832-41
Saha, Somnath; Beach, Mary Catherine (2011) The impact of patient-centered communication on patients' decision making and evaluations of physicians: a randomized study using video vignettes. Patient Educ Couns 84:386-92
Saha, Somnath; Sanders, David S; Korthuis, Philip Todd et al. (2011) The role of cultural distance between patient and provider in explaining racial/ethnic disparities in HIV care. Patient Educ Couns 85:e278-84
Saha, Somnath; Jacobs, Elizabeth A; Moore, Richard D et al. (2010) Trust in physicians and racial disparities in HIV care. AIDS Patient Care STDS 24:415-20
Beach, Mary Catherine; Saha, Somnath; Korthuis, P Todd et al. (2010) Differences in patient-provider communication for Hispanic compared to non-Hispanic white patients in HIV care. J Gen Intern Med 25:682-7
Kinsman, Helen; Roter, Debra; Berkenblit, Gail et al. (2010) ""We'll do this together"": the role of the first person plural in fostering partnership in patient-physician relationships. J Gen Intern Med 25:186-93