New psychological tool to predict patient adherence to HIV treatment

published on April 7, 2004

(Vancouver) – A psychological evaluation to determine whether HIV/AIDS patients will adhere to drug therapy could significantly improve health outcomes and result in more efficient use of health-care dollars, say Centre researchers developing the new measurement tool.

The semi-structured interview, comprising 40-plus set questions, will help identify any potential psychological barriers to adherence and address ways patients may overcome these challenges to optimize treatment. Interview results will not preclude patients from receiving treatment.

Drs. Victoria Alfonso and Dr. Josie Geller, clinical psychologists working at the centre, have completed in-depth interviews with a cross-section of HIV/AIDS patients to determine psychological barriers to adherence. Reported barriers included lack of social support, depression and being skeptical about the efficacy of the medications. Many patients interviewed were also wary of significant side effects from anti-HIV drugs.

The Centre is developing a measurement tool based on its interview findings and a comprehensive audit of existing data on adherence, says Geller.

“Our research identified seven psychological variables that have been associated with adherence to drug treatment. We are now testing a measurement tool based on this research to determine its ability to predict when patients are ready for treatment,” says Geller.

People with HIV are prescribed a complicated combination of drugs to suppress the disease. Complete adherence is key to therapeutic success. Partial adherence to an anti-HIV drug regimen poses a higher risk to patients of developing drug-resistant strains of the virus.

The study’s work can be of great significance to HIV patients and the health-care system, says Dr. Julio Montaner, acting director of the Centre.

“This evaluation should help us improve health outcomes, increase adherence to HIV drugs and reduce drug resistance, while saving on medication costs,” says Montaner.

The Centre approached Geller after she successfully developed a measurement tool for patients diagnosed with eating disorders. Geller's tool in this population predicted when patients were ready to begin treatment, whether they would drop out once enrolled and whether they would relapse six-months after leaving treatment.

The Centre project is considered to be the first in the HIV/AIDS field to develop and validate a comprehensive, psychological evaluation, says Geller.

“It is somewhat revolutionary to have psychologists involved in HIV/AIDS treatment because so much attention has been focused on medications. Our project is cutting-edge because it translates the experiences of individuals living with HIV into an empirical tool that can be used by health care providers,” says Geller.

The Centre study is also initiating a pilot project to create an intervention that will help patients prepare for treatment. Patients will be encouraged to undergo brief counseling to target psychological barriers to adherence

Founded in 1992 by St. Paul’s Hospital and the provincial Ministry of Health, the B.C. Centre for Excellence in HIV/AIDS is a key provincial resource seeking to improve the health of people with HIV through the development, ongoing monitoring and dissemination of comprehensive investigative and treatment programs for HIV and related diseases. St. Paul’s Hospital is one of six health care facilities operated by Providence Health Care, Canada’s largest faith-based health care organization.

BC Centre for Excellence in HIV/AIDS

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New psychological tool to predict patient adherence to HIV treatment

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