Clinical Demonstration of a Nursing Intervention to Improve the Medication Adherence of Patients with HIV/AIDS
We propose to evaluate the effectiveness of a nursing intervention to improve medication adherence among an inner city clinic population of HI V-infected patients. We have previously demonstrated the efficacy of the intervention, Adherence Through Home Education and Nursing Assessment (ATHENA), in a randomized controlled clinical trial. The effectiveness of the intervention will be pilot tested in a randomized, cross-over pilot study. The proposed study is the next step in a program of clinical scholarship aimed at the development of practical, evidence-based nursing interventions to improve the medication adherence of patients living with HIV/AIDS. This study aims to translate the results of the ATHENA study into the real world of clinical practice at the Nathan Smith Clinic, an HIV/AIDS dedicated outpatient clinic at Yale-New Haven Hospital. The intervention to be evaluated is a program of home visits delivered by a nurse and a peer counselor. The patient populations that will receive this intervention are: 1) HIV-infected persons who are clinically eligible for antiretroviral therapy but who have difficulty adhering to a medication regimen; and 2) those who are HIV/HCV co-infected. Evaluation and outcome measures will include patient self-report of medication adherence, biologic measures of clinical progression, and observations of the intervention process and impact of the project on the clinical environment as reported by clinic staff. The expected impact of this project is an improvement in the clinical outcomes and long term prognosis for the most difficult to treat patients living with HIV/AIDS - those who are unable to adhere to a regimen of highly active antiretroviral therapy (HAART) and those who are coinfected with hepatitis C virus (HCV). The project is relevant to HIV/AIDS clinical care settings in both the developed and the developing world. If proved effective, the intervention may also be useful for other patient populations living with chronic conditions that require life-long adherence to demanding medical regimens.
Funded by the Beatrice Renfield-Yale School of Nursing Clinical Research Initiatives Fund
