Pharmacy World & Science

, Volume 32, Issue 6, pp 776–786 | Cite as

Antiretroviral adherence program in HIV patients: a feasibility study in the Swiss HIV Cohort Study

  • Isabelle Krummenacher
  • Matthias Cavassini
  • Olivier Bugnon
  • Rebecca Spirig
  • Marie P. Schneider
  • The Swiss HIV Cohort Study
Research Article


Objective To evaluate the feasibility of a comprehensive, interdisciplinary adherence program aimed at HIV patients. Setting Two centers of the Swiss HIV Cohort Study: Lausanne and Basel. Method 6-month, pilot, quasi-experimental, 2-arm design (control and intervention). Patients starting a first or second combined antiretroviral therapy line were invited to participate in the study. Patients entering the intervention arm were proposed a multifactorial intervention along with an electronic drug monitor. It consisted of a maximum of six 30-min sessions with the interventionist coinciding with routine HIV check-up. The sessions relied on individualized semi-structured motivational interviews. Patients in the control arm used directly blinded EDM and did not participate in motivational interviews. Main outcome measures Rate of patients’ acceptance to take part in the HIV-adherence program and rate of patients’ retention in this program assessed in both intervention and control groups. Persistence, execution and adherence. Results The study was feasible in one center but not in the other one. Hence, the control group previously planned in Basel was recruited in Lausanne. Inclusion rate was 84% (n = 21) in the intervention versus 52% (n = 11) in the control group (P = 0.027). Retention rate was 91% in the intervention versus 82% in the control group (P = ns). Regarding adherence, execution was high in both groups (97 vs. 95%). Interestingly, the statistical model showed that adherence decreased more quickly in the control versus the intervention group (interaction group × time P < 0.0001). Conclusion The encountered difficulties rely on the implementation, i.e., on the program and the health care system levels rather than on the patient level. Implementation needs to be evaluated further; to be feasible a new adherence program needs to fit into the daily routine of the centre and has to be supported by all trained healthcare providers. However, this study shows that patients’ adherence behavior evolved differently in both groups; it decreased more quickly over time in the control than in the intervention group. RCTs are eventually needed to assess the clinical impact of such an adherence program and to verify whether skilled pharmacists can ensure continuity of care for HIV outpatients.


Antiretroviral therapy Electronic drug monitoring Feasibility studies HIV Intervention Medication adherence Motivational interviewing Pharmacists Switzerland 



We acknowledge Anne-Catherine Lange and Dr Bernard Vrijens, Pharmionic Research Center, Belgium, for the analysis of the adherence data. We also acknowledge John K. Wagg for his useful comments on the manuscript.


This study was funded by a grant (no 493) of the Swiss HIV Cohort Study.

Conflicts of interest

Matthias Cavassini received travel grants from Abbott, Boehringer-Ingelheim, Gilead and Roche.


  1. 1.
    Bangsberg DR, Perry S, Charlebois ED, Clark RA, Roberston M, Zolopa AR, et al. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS. 2001;15:1181–3.CrossRefPubMedGoogle Scholar
  2. 2.
    Bangsberg DR. Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clin Infect Dis. 2006;43:939–41.CrossRefPubMedGoogle Scholar
  3. 3.
    Simpson SH, Eurich DT, Majumdar SR, Padwal RS, Tsuyuki RT, Varney J, et al. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ. 2006;333:15.CrossRefPubMedGoogle Scholar
  4. 4.
    Glass TR, de Geest S, Weber R, Vernazza PL, Rickenbach M, Furrer H, et al. Correlates of self-reported nonadherence to antiretroviral therapy in HIV-infected patients: the Swiss HIV Cohort Study. J Acquir Immune Defic Syndr. 2006;41:385–92.CrossRefPubMedGoogle Scholar
  5. 5.
    World Health Organization. Adherence to long-term therapies. Evidence for action. (2003). ISBN 9789241545990, 9241545992Google Scholar
  6. 6.
    Liu H, Golin CE, Miller LG, Hays RD, Beck CK, Sanandaji S, et al. A comparison study of multiple measures of adherence to HIV protease inhibitors. Ann Intern Med. 2001;134:968–77.PubMedGoogle Scholar
  7. 7.
    Rosen MI, Dieckhaus K, McMahon TJ, Valdes B, Petry NM, Cramer J, et al. Improved adherence with contingency management. AIDS Patient Care STDS. 2007;21:30–40.CrossRefPubMedGoogle Scholar
  8. 8.
    Matsuyama JR, Mason BJ, Jue SG. Pharmacists’ interventions using an electronic medication-event monitoring device’s adherence data versus pill counts. Ann Pharmacother. 1993;27:851–5.PubMedGoogle Scholar
  9. 9.
    Ammassari A, Murri R, Pezzotti P, Trotta MP, Ravasio L, De Longis P, et al. Self-reported symptoms and medication side effects influence adherence to highly active antiretroviral therapy in persons with HIV infection. J Acquir Immune Defic Syndr. 2001;28:445–9.PubMedGoogle Scholar
  10. 10.
    Spirig R, Moody K, Battegay M, de Geest S. Symptom management in HIV/AIDS: advancing the conceptualization. ANS Adv Nurs Sci. 2005;28:333–44.PubMedGoogle Scholar
  11. 11.
    Vogl D, Rosenfeld B, Breitbart W, Thaler H, Passik S, McDonald M, et al. Symptom prevalence, characteristics, and distress in AIDS outpatients. J Pain Symptom Manage. 1999;18:253–62.CrossRefPubMedGoogle Scholar
  12. 12.
    Wilson HS, Hutchinson SA, Holzemer WL. Reconciling incompatibilities: a grounded theory of HIV medication adherence and symptom management. Qual Health Res. 2002;12:1309–22.CrossRefPubMedGoogle Scholar
  13. 13.
    Simoni JM, Pearson CR, Pantalone DW, Marks G, Crepaz N. Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load: a meta-analytic review of randomized controlled trials. J Acquir Immune Defic Syndr. 2006;43:S23–35.CrossRefPubMedGoogle Scholar
  14. 14.
    Swiss HIV Cohort Study. The Swiss HIV Cohort Study. (2010). Updated 2 Feb 2210; cited 27 Apr 2010.
  15. 15.
    Miller WR, Rollnick S, Conforti K. Motivational interviewing: preparing people for change. 2nd ed. New York: The Guilford Press; 2002. ISBN 1572305630, 978-1572305632.Google Scholar
  16. 16.
    Cooperman NA, Arnsten JH. Motivational interviewing for improving adherence to antiretroviral medications. Curr HIV/AIDS Rep. 2005;2:159–64.CrossRefPubMedGoogle Scholar
  17. 17.
    Fisher JD, Fisher WA, Amico KR, Harman JJ. An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol. 2006;25:462–73.CrossRefPubMedGoogle Scholar
  18. 18.
    Fisher JD, Amico KR, Fisher WA, Harman JJ. The information-motivation-behavioral skills model of antiretroviral adherence and its applications. Curr HIV/AIDS Rep. 2008;5:193–203.CrossRefPubMedGoogle Scholar
  19. 19.
    Bandura A. Health functioning. In: Bandura A, editor. Self-efficacy, the exercise of control. New York: W.H. Freeman and Co; 1997. p. 259–318. ISBN 0716728508, 978-0716728504.Google Scholar
  20. 20.
    Munro SA, Lewin SA, Swart T, Volmink J. A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS? BMC Public Health. 2007;7:104.CrossRefPubMedGoogle Scholar
  21. 21.
    Glass TR, de Geest S, Hirschel B, Battegay M, Furrer H, Cavassini M, et al. Self-reported non-adherence to antiretroviral therapy repeatedly assessed by two questions predicts treatment failure in virologically suppressed patients. Antivir Ther. 2008;13:77–85.PubMedGoogle Scholar
  22. 22.
    Bakken S, Holzemer WL, Brown MA, Powell-Cope GM, Turner JG, Inouye J, et al. Relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS. AIDS Patient Care STDS. 2000;14:189–97.CrossRefPubMedGoogle Scholar
  23. 23.
    Fleury J, Cameron K. The index of readiness. In: Strickland OL, Dilorio C, editors. Measurement of Nursing Outcomes. 2nd ed. New York: Springer Publishing Company; 2003. p. 265–75. ISBN 0826117953, 978082611795.Google Scholar
  24. 24.
    Norbeck JS, Lindsey AM, Carrieri VL. The development of an instrument to measure social support. Nurs Res. 1981;30:264–9.PubMedGoogle Scholar
  25. 25.
    Wu AW, Rubin HR, Mathews WC, Ware JE Jr, Brysk LT, Hardy WD, et al. A health status questionnaire using 30 items from the Medical Outcomes Study. Preliminary validation in persons with early HIV infection. Med Care. 1991;29:786–98.CrossRefPubMedGoogle Scholar
  26. 26.
    Brown RL, Rounds LA. Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. Wis Med J. 1995;94:135–40.PubMedGoogle Scholar
  27. 27.
    De Geest S, Abraham I, Gemoets H, Evers G. Development of the long-term medication behaviour self-efficacy scale: qualitative study for item development. J Adv Nurs. 1994;19:233–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Lepine JP. L’échelle HAD (hospital anxiety and depression scale). In: Guelfi JD, editor. Évaluation clinique standardisée en psychiatrie, tome II. Éditions médicales Pierre-Fabre ed. 1997. p. 367–72. ISBN 2867870828.Google Scholar
  29. 29.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.CrossRefPubMedGoogle Scholar
  30. 30.
    Vincenzi CB, Moody K, Spirig R. Development and pretesting of a set of symptom assessment tools in HIV: the HIV symptom experience assessment scale and the HIV symptom manageability scale. Appl Nurs Res. 2009;22:204–10.CrossRefPubMedGoogle Scholar
  31. 31.
    Vrijens B, Goetghebeur E. Comparing compliance patterns between randomized treatments. Control Clin Trials. 1997;18:187–203.CrossRefPubMedGoogle Scholar
  32. 32.
    Diiorio C, McCarty F, Resnicow K, McDonnell HM, Soet J, Yeager K, et al. Using motivational interviewing to promote adherence to antiretroviral medications: a randomized controlled study. AIDS Care. 2008;20:273–83.CrossRefPubMedGoogle Scholar
  33. 33.
    Catz SL, Kelly JA, Bogart LM, Benotsch EG, McAuliffe TL. Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychol. 2000;19:124–33.CrossRefPubMedGoogle Scholar
  34. 34.
    Gordillo V, del AJ, Soriano V, Gonzalez-Lahoz J. Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS. 1999;13:1763–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Roberts KJ. Barriers to and facilitators of HIV-positive patients’ adherence to antiretroviral treatment regimens. AIDS Patient Care STDS. 2000;14:155–68.CrossRefPubMedGoogle Scholar
  36. 36.
    Simoni JM, Frick PA, Huang B. A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy. Health Psychol. 2006;25:74–81.CrossRefPubMedGoogle Scholar
  37. 37.
    Levine AJ, Hinkin CH, Castellon SA, Mason KI, Lam MN, Perkins A, et al. Variations in patterns of highly active antiretroviral therapy (HAART) adherence. AIDS Behav. 2005;9:355–62.CrossRefPubMedGoogle Scholar
  38. 38.
    Deschamps AE, Graeve VD, van Wijngaerden E, De Saar V, Vandamme AM, van Varenbergh K, et al. Prevalence and correlates of nonadherence to antiretroviral therapy in a population of HIV patients using medication event monitoring system. AIDS Patient Care STDS. 2004;18:644–57.CrossRefPubMedGoogle Scholar
  39. 39.
    Burnier M, Schneider MP, Chiolero A, Stubi CL, Brunner HR. Electronic compliance monitoring in resistant hypertension: the basis for rational therapeutic decisions. J Hypertens. 2001;19:335–41.CrossRefPubMedGoogle Scholar
  40. 40.
    Cramer J, Rosenheck R, Kirk G, Krol W, Krystal J. Medication compliance feedback and monitoring in a clinical trial: predictors and outcomes. Value Health. 2003;6:566–73.CrossRefPubMedGoogle Scholar
  41. 41.
    De Geest S, Schafer-Keller P, Denhaerynck K, Thannberger N, Kofer S, Bock A, et al. Supporting medication adherence in renal transplantation (SMART): a pilot RCT to improve adherence to immunosuppressive regimens. Clin Transplant. 2006;20:359–68.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Isabelle Krummenacher
    • 1
  • Matthias Cavassini
    • 2
  • Olivier Bugnon
    • 1
    • 3
  • Rebecca Spirig
    • 4
    • 5
  • Marie P. Schneider
    • 3
    • 6
  • The Swiss HIV Cohort Study
  1. 1.Community Pharmacy Research Unit, Pharmaceutical Sciences SectionUniversities of Geneva & LausanneLausanneSwitzerland
  2. 2.Service of Infectious Disease, Centre Hospitalier Universitaire VaudoisUniversity of LausanneLausanneSwitzerland
  3. 3.Community Pharmacy, Department of Ambulatory Care and Community MedicineUniversity of LausanneLausanneSwitzerland
  4. 4.Division of Clinical Nursing ScienceUniversity of BaselBaselSwitzerland
  5. 5.Institute of Nursing ScienceUniversity of BaselBaselSwitzerland
  6. 6.Community Pharmacy Research UnitPharmacie de la Policlinique Médicale UniversitaireLausanneSwitzerland

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