The recent development of highly active antiretroviral (AR) therapy represents a tremendous leap forward in treatment of HIV infection. Unfortunately, barriers make adherence difficult. Inadequate adherence often produces viral resistance and treatment failure. Consequently, adherence has become a critical determinant of regimen efficacy. Several studies have identified the patient-provider relationship as a determinant of adherence. In studies of patients with other chronic illnesses, health outcomes linked to adherence are improved when patients are trained to participate more in medical decision-making. Patient participation is increasingly advocated for patients with HIV to enhance adherence; however, the effect of participation on adherence to ARs has never been directly assessed.
The specific aims of the study are: 1) To test whether an intervention to increase HIV-infected patients' participation in decision-making regarding AR therapy improves their adherence and viral load. Based on my prior model of patient participation, I will develop an intervention that trains patients with HIV to participate in decision-making and provides feedback and follow-up over a 12 week period. I will then use a randomized controlled trial to test this intervention among HIV-infected patients who are starting a new AR at UNC Infectious Diseases. 2) To evaluate the mechanisms of action of an intervention aimed at increasing patient participation in medical decision-making on adherence. I will assess the impact of the intervention on patient participation as well as patient and physician satisfaction with the medical visit and the impact of patient participation on adherence. The study is designed to build upon my prior research and facilitate my transition from post-doctoral fellow to independent investigator. Carrying out the proposed study will help me to meet my career goals: to achieve independence as a clinical researcher by evaluating factors to improve adherence to AR therapy and 2) to develop a deeper understanding of the relationship between patient participation and adherence to chronic medical therapy.
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