When taken as prescribed, antiretroviral therapy (ART) has dramatic effects on the health and well-being of HIV+ individuals. HIV+ persons on ART, however, must adhere rigorously to an often complex and side-effect prone therapeutic regimen to benefit from this therapy, and to avoid contracting treatment resistant strains of HIV that can potentially be transmitted to others. While 95% adherence to ART is critical for viral suppression, actual adherence rates of 60-70% and lower are common in HIV+ clinical samples. Although suboptimal adherence to ART may have extremely serious individual and public health consequences, few theory-based, rigorously evaluated interventions to increase adherence to ART have been implemented and found to be effective in clinical care settings. Most extant approaches to enhancing adherence to ART involve labor-intensive, individually focused interventions, which have yet to demonstrate efficacy, and which are too intensive and too expensive to deploy widely. Overall, the standard-of-care for ART adherence in HIV clinical settings is ad hoc and minimal. This proposal involves the development, piloting, implementation, and rigorous evaluation of an innovative approach to assisting HIV+ individuals to adhere to ART. It uses the Information - Motivation - Behavioral Skills (IMB) model of adherence (J. Fisher, 2000a; J. Fisher et al., 2002a; W. Fisher et al., in press) to design, implement and evaluate an individualized, interactive, cost-effective, computer-assisted ART adherence intervention that can be widely implemented in clinical care settings. The intervention will use Motivational Interviewing techniques (e.g., Rollnick et al., 2000) as a delivery system for conveying individually tailored ART adherence-related information, motivation, and behavioral skills (IMB) content to HIV+ patients about to begin ART, to facilitate high levels of initial adherence, and to patients on ART, to enhance adherence and promote maintenance of optimal levels of adherence. The ART adherence intervention will be compared with an appropriate standard-of-care control group in terms of mutiple indicators of ART adherence in evaluation outcome research over an 18-month follow-up interval. The standard-of-care control group will also permit us to study the natural history of ART adherence and its longitudinal dynamics, as a function of factors such as changes in subjective and objective health, substance abuse status, disease stage, length of time on ART, and other factors. This, in its own right, also represents an important contribution to ART adherence research.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH066684-04
Application #
7089997
Study Section
Special Emphasis Panel (ZRG1-AARR-8 (04))
Program Officer
Stirratt, Michael J
Project Start
2003-09-19
Project End
2009-06-30
Budget Start
2006-07-01
Budget End
2009-06-30
Support Year
4
Fiscal Year
2006
Total Cost
$1,084,443
Indirect Cost
Name
University of Connecticut
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
614209054
City
Storrs-Mansfield
State
CT
Country
United States
Zip Code
06269
Fisher, Jeffrey D; Amico, K Rivet; Fisher, William A et al. (2011) Computer-based intervention in HIV clinical care setting improves antiretroviral adherence: the LifeWindows Project. AIDS Behav 15:1635-46
Norton, Wynne E; Amico, K Rivet; Fisher, William A et al. (2010) Information-motivation-behavioral skills barriers associated with intentional versus unintentional ARV non-adherence behavior among HIV+ patients in clinical care. AIDS Care 22:979-87
Chaudoir, Stephenie R; Fisher, Jeffrey D (2010) The disclosure processes model: understanding disclosure decision making and postdisclosure outcomes among people living with a concealable stigmatized identity. Psychol Bull 136:236-56
Amico, K Rivet; Barta, William; Konkle-Parker, Deborah J et al. (2009) The information-motivation-behavioral skills model of ART adherence in a Deep South HIV+ clinic sample. AIDS Behav 13:66-75
Fisher, Jeffrey D; Amico, K Rivet; Fisher, William A et al. (2008) The information-motivation-behavioral skills model of antiretroviral adherence and its applications. Curr HIV/AIDS Rep 5:193-203
Amico, K Rivet; Harman, Jennifer J; O'Grady, Megan A (2008) Attrition and related trends in scientific rigor: a score card for ART adherence intervention research and recommendations for future directions. Curr HIV/AIDS Rep 5:172-85
Amico, K Rivet; Konkle-Parker, D J; Cornman, D H et al. (2007) Reasons for ART non-adherence in the Deep South: adherence needs of a sample of HIV-positive patients in Mississippi. AIDS Care 19:1210-8
Starace, Fabrizio; Massa, Alessandra; Amico, K Rivet et al. (2006) Adherence to antiretroviral therapy: an empirical test of the information-motivation-behavioral skills model. Health Psychol 25:153-62
Amico, K Rivet; Harman, Jennifer J; Johnson, Blair T (2006) Efficacy of antiretroviral therapy adherence interventions: a research synthesis of trials, 1996 to 2004. J Acquir Immune Defic Syndr 41:285-97
Amico, K Rivet; Fisher, William A; Cornman, Deborah H et al. (2006) Visual analog scale of ART adherence: association with 3-day self-report and adherence barriers. J Acquir Immune Defic Syndr 42:455-9

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