Lessons learned from an HIV adherence pilot study in the Deep South.

OBJECTIVE: Adherence to treatment for chronic illnesses, including HIV disease, is a complex process, and needs practical interventions in poorly resourced clinic settings.
METHODS: This study tested the feasibility of an adherence intervention in 73 HIV-infected individuals in a Deep South public clinic based on Fisher & Fisher's Information-Motivation-Behavioral Skills Model.
RESULTS: There was high baseline adherence and unexpectedly high clinic attrition, and 27% of the intervention group received less than one-quarter of the planned intervention contacts. Refill rate was the adherence measure that correlated best with HIV viral load and CD4 count, and there was poor use of electronic adherence monitoring (MEMS). Interviewed individuals expressed positive feelings about audio-supported computer-assisted survey instruments (ACASI) and the intervention support.
CONCLUSIONS: This process evaluation showed feasible study components in this population and setting. Lessons learned included: (1) clinic retention is an important part of adherence; (2) telephone interventions may need to add additional technology and flexibility to maximize dose; (3) ongoing fidelity monitoring is important with motivational interviewing; (4) refill rate was the most accurate adherence assessment; (5) MEMS was not well-accepted; (6) ACASI was easily used in this population; and (7) individuals appreciated adherence support from a consistent caring individual.