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Multisystemic therapy for poorly adherent youth with HIV: Results from a pilot randomized controlled trial

机译：HIV依从性差的年轻人的多系统治疗：一项随机对照试验的结果

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Adherence to antiretroviral medication for the treatment of HIV is a significant predictor of virologic suppression and is associated with dramatic reductions in mortality and morbidity and other improved clinical outcomes for pediatric patient populations. Effective strategies for addressing adherence problems in youth infected with HIV are needed and require significant attention to the complex interplay of multiple, interacting causal risk factors that lead to poor self-care. Within the context of a pilot randomized trial, we evaluated the feasibility and initial efficacy of a multisystemic therapy (MST) intervention adapted to address HIV medication adherence problems against a usual care condition that was bolstered with a single session of motivational interviewing (MI). For 34 participating youth, health outcomes (viral load [VL] and CD4 count) were obtained from approximately 10 months pre-baseline through approximately 6 months post-baseline and self-reported medication adherence outcomes were obtained quarterly from baseline through 9 months post-baseline. Using mixed-effects regression models we examined within- and between-groups differences in the slopes of these outcomes. Feasibility was supported, with a 77% recruitment rate and near-maximal treatment and research retention and completion rates. Initial efficacy also was supported, with the MST condition but not the MI condition demonstrating statistically and clinically significant VL reductions following the start of treatment. There was also some support for improved CD4 count and self-reported medication adherence for the MST but not the MI condition. MST was successfully adapted to improve the health outcomes of youth poorly adherent to antiretroviral medications. Replication trials and studies designed to identify the mechanisms of action are important next steps. ? 2013
机译：坚持使用抗逆转录病毒药物治疗HIV是病毒学抑制的重要预测指标，并与死亡率和发病率的显着降低以及小儿患者人群的其他临床结局有关。需要有效的策略来解决感染艾滋病毒的年轻人的依从性问题，并且需要大量关注导致不良自我护理的多种相互作用的因果风险因素之间的复杂相互作用。在一项试点随机试验的背景下，我们评估了多系统疗法（MST）干预措施的可行性和初始功效，该干预措施针对单次动机访谈（MI）来支持针对常规护理条件下的HIV药物依从性问题进行了调整。对于34名参与研究的青年，从基线前约10个月到基线后约6个月获得了健康结局（病毒载量[VL]和CD4计数），并且从基线到第9个月后每季度获得了自我报告的药物依从性结局。基线。使用混合效果回归模型，我们检查了这些结果的斜率在组内和组间差异。可行性得到了支持，招聘率为77％，治疗和研究的保留率和完成率均接近最高。最初的疗效也得到了支持，其中MST病情而非MI病情表明在治疗开始后VL降低在统计学上和临床上均具有统计学意义。对于MST改善的CD4计数和自我报告的药物依从性也有一定的支持，但MI状况却不支持。 MST成功地适应了改善对抗逆转录病毒药物依从性差的年轻人的健康状况的需求。旨在确定作用机制的复制试验和研究是重要的下一步。 ？ 2013年

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