Cue-dose training with monetary reinforcement |
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Authors: | Dr Michael O Rigsby MD Marc I Rosen MD John E Beauvais PhD Joyce A Cramer BS Petrie M Rainey MD PhD Stephanie S O’Malley PhD Kevin D Dieckhaus MD Bruce J Rounsaville MD |
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Institution: | (1) the Medical Service, West Haven, Conn;(2) Psychiatry Service, West Haven, Conn;(3) Department of Veterans Affairs Connecticut Healthcare System, Psychology Service, West Haven, Conn;(4) Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn;(5) Department of Psychiatry, Yale University School of Medicine, New Haven, Conn;(6) Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Conn;(7) Department of Internal Medicine, University of Connecticut, Farmington, Conn;(8) VA Connecticut Healthcare System, Infectious Diseases 111-1, 950 Campbell Ave., 06516 West Haven, CT |
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Abstract: | OBJECTIVE: To assess the feasibility and efficacy of two interventions for improving adherence to antiretroviral therapy regimens in
HIV-infected subjects compared with a control intervention.
DESIGN: Randomized, controlled, pilot study.
SETTING: Department of Veterans Affairs HIV clinic and community-based HIV clinical trials site.
PARTICIPANTS: Fifty-five HIV-infected subjects on stable antiretroviral therapy regimens. Subjects were predominantly male (89%) and African
American (69%), and had histories of heroin or cocaine use (80%).
INTERVENTIONS: Four weekly sessions of either nondirective inquiries about adherence (control group, C), cue-dose training, which consisted
of the use of personalized cues for remembering particular dose times, and feedback about medication taking using Medication
Event Monitoring System (MEMS) pill bottle caps, which record time of bottle opening (CD group), or cue-dose training combined
with cash reinforcement for correctly timed bottle opening (CD+CR).
MEASUREMENTS: Opening of the pill bottle within 2 hours before or after a predetermined time was measured by MEMS.
RESULTS: Adherence to the medication as documented by MEMS was significantly enhanced during the 4-week training period in the CD+CR
group, but not in the CD group, compared with the control group. Improvement was also seen in adherence to antiretroviral
drugs that were not the object of training and reinforcement. Eight weeks after training and reinforcement were discontinued,
adherence in the cash-reinforced group returned to near-baseline levels.
CONCLUSIONS: Cue-dose training with cash reinforcement led to transient improvement in adherence to antiretroviral therapy in a population
including mostly African Americans and subjects with histories of drug abuse. However, we were not able to detect any sustained
improvement beyond the active training period, and questions concerning the timing and duration of such an intervention require
further study. Randomized, controlled clinical studies with objective measures of adherence can be conducted in HIV-infected
subjects and should be employed for further evaluation of this and other adherence interventions.
This study was supported by grants K20-DA000191-05 (MIR) and VA Merit Review 1241 (MIR), P50-DA09241 (BJR) and a General Clinical
Research Center grant (M01RR06192) to the University of Connecticut Health Center, Farmington, Conn. |
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Keywords: | adherence MEMS contingency management HIV infection antiretroviral |
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