development of a computer-based tailored information application to improve hiv-related treatment...
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Development of a Computer-Based Tailored Information Application to Improve HIV-Related Treatment Adherence: Preliminary Findings
Raymond L Ownby, MD, PhDNova Southeastern UniversityFort Lauderdale FL
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Medication adherence in HIVAdherence needed to suppress
viral replication = 80-95%Typical adherence = 60-70%Viral suppression decreased
risk of infecting othersViral suppression better clinical
outcomes
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Health literacyKnowledge, abilities, and skills
required to attain a desired state of health
Related to multiple clinical variables◦Disease control (diabetes)◦Hospitalization (Medicare data)◦Death (Medicare data)◦Medication adherence (HIV)
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IMB Model
Information: How meds work, how to cope with side effects
Motivation: Social support, depressionBehavioral Skills: How to remember to
take medications, cope with obstacles
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Tailored informationPersonalizationIndividualized feedbackEnhancing perceived relevanceIncreases impact on patient behavior
◦ 10%+ increase in dietary intake of fruits◦ 10-15% improvement in adherence in
older adults treated for memory problems
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The intervention
An overview of topics
Instructional theory
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A Flash animation provides a preliminary overview of the virus life cycle
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The animation emphasizes specific stages in the viral life cycle
These stages are later reviewed in discussion of how medications work
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A key aspect of the intervention is interactivity
Participant learning is assessed with questions
If needed, content is retaught
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MEMSMedication Event
Monitoring System
Adherence indices◦Taken (e.g.,30 pills in 30
days)◦Correct (e.g., 1pill/24 hours)◦Scheduled (e.g.,+/- 2 hours)
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Sample (n = 110)
Minimum Maximum Mean SD
Age 20 67 47.1 9.0
Years Positive 0 38 15.5 8.0
Years Treated 0 30 11.6 7.3
% Correct 6.9 100.0 81.2 21.9
% Schedule 0 100.0 70.4 27.6
CD4 62 1574 486.7 264.6
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Race/Ethnicity
Frequenc
y Percent
Asian 2 1.8
Black/African American 63 57.3
Black/Caribbean 3 2.7
White/European 42 38.2
Gender
Women 30 27.3
Men 80 72.7
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Education
11th grade or less 35 31.8
High school / GED 43 39.1
Some college/ Technical school 18 16.4
College graduate (BA or BS) 10 9.1
Master's degree 2 1.8
Total 108 98.2
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Results: LifeWindows IMB scale
Information◦ F = 7.141, p = 0.001
◦ f = 0.35, a medium to large effect size
Motivation◦ F = 0.75, p = 0.48
Behavioral Skills◦ F = 8.64, p < 0.001
◦ f = 0.39, a medium to large effect
Based on completers◦ 3 drop outs
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Results: Self Efficacy, DepressionPatient-Provider Interaction
◦F = 5.17, p = 0.007; f = 0.29, medium effect
Healthcare Self-efficacy ◦F = 11.71, p = 0.001; f = 0.39,
medium to large effectDepression and Social Support
◦ Not significant
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Results: AdherencePercent Taken
◦Number of doses / month◦F = 4.21, p = 0.04; f = 0.25, a
medium effectPercent Correct
◦Number of doses / day◦F = 5.31, p = 0.02; f = 0.27, a
medium effect
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ConclusionsParticipation in the intervention is
associated with improved Information Behavioral skills Self-reported ability to work with clinicians Healthcare self-efficacy
Not associated with improved Motivation Social support Mood
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DiscussionPreliminary results
◦Study not yet completedClinical vs. statistical significance
◦Medium effect sizes comparable to other behavioral interventions
◦Adjunct to other interventionsPre-post design (no control group)
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Future directionsOther languagesOther aspects of treatment adherence
◦Appointments◦Diet, exercise
Other disorders◦Diabetes◦Congestive heart failure
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Support:Support for this study was
provided by grant R21MH086491 to Dr. Ownby from the National Institute on Mental Health.
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Collaborators
Drenna Waldrop-Valverde, PhDJosh Caballero, PharmDRosemary Davenport, RN, MSN,
ARNPRobin Jacobs, PhD