1. Section Editor(s): Kennedy, Maureen Shawn MA, RN

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Patients with HIV must strictly adhere to their medication regimens in order to decrease their viral load and increase their immune cell CD4+ counts. Behavioral theorists have long observed that behavior change depends on motivation, not just knowledge and skills. To determine if an individually tailored program administered by a nurse could promote adherence, researchers recruited more than 200 participants from a public HIV and AIDS clinic in Houston and randomized them into two groups.


The average age of the study participants was 42, and more than half were male, black, and unemployed. One group received education tailored to their needs, as identified by a nurse experienced in HIV care, focusing primarily on medication knowledge, adherence, management of adverse effects, "role performance," and the client-provider relationship. The remaining participants continued in their usual care. All participants returned to the clinic at one, three, and six months to complete surveys on their medication adherence. In addition, adherence was measured by pill counts, review of pharmacy refill records, and the use of a pill-bottle cap that recorded the day and time of each opening. At six months, overall adherence was below 35% for all measures used, and there were no differences noted between the intervention and the control groups.


The tailored education program did not demonstrate any benefit in this population. This may have been due to limitations of the intervention itself or to the degree of participants' true intent to increase their adherence to treatment as opposed to simply receiving remuneration for participation in the study. Reached for comment, lead author William Holzemer said that "perhaps this intervention did not show any benefit because of the chaotic lives of these participants and because more time is needed for learning adherence-related skills."

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Holzemer WL, et al. Nurs Res 2006;55(3):189-97.