Physician-delivered motivational interviewing to improve adherence and retention in care among challenging HIV-infected patients in Argentina (COPA2): study protocol for a cluster randomized controlled trial
Abstract Background “Challenging” HIV-infected patients, those not retained in treatment, represent a critical focus for positive prevention, as linkage to care, early initiation of antiretroviral therapy, adherence and retention in treatment facilitate viral suppression, thus optimizing health and...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-07-01
|
| Series: | Trials |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13063-018-2758-5 |
| _version_ | 1811223323397324800 |
|---|---|
| author | Omar Sued Isabel Cassetti Diego Cecchini Pedro Cahn Lina Bofill de Murillo Stephen M. Weiss Lissa N. Mandell Manasi Soni Deborah L. Jones |
| author_facet | Omar Sued Isabel Cassetti Diego Cecchini Pedro Cahn Lina Bofill de Murillo Stephen M. Weiss Lissa N. Mandell Manasi Soni Deborah L. Jones |
| author_sort | Omar Sued |
| collection | DOAJ |
| description | Abstract Background “Challenging” HIV-infected patients, those not retained in treatment, represent a critical focus for positive prevention, as linkage to care, early initiation of antiretroviral therapy, adherence and retention in treatment facilitate viral suppression, thus optimizing health and reducing HIV transmission. Argentina was one of the first Latin American countries to guarantee HIV prevention, diagnosis and comprehensive care services, including antiretroviral medication, which removed cost and access as barriers. Yet, dropout occurs at every stage of the HIV continuum. An estimated 110,000 individuals are HIV-infected in Argentina; of these, 70% have been diagnosed and 54% were linked to care. However, only 36% have achieved viral suppression and 31% of those diagnosed delayed entry to care. To achieve meaningful reductions in HIV infection at the community level, innovative strategies must be developed to re-engage patients. Motivational Interviewing (MI) is a patient-centered approach and has been used by therapists in Central and South America to enhance motivation and commitment in substance use and risk reduction. Our pilot feasibility study utilized culturally tailored MI in physicians to target patients not retained in treatment in public and private clinics in Buenos Aires, Argentina. Results demonstrated that a physician-based MI intervention was feasible and effective in enhanced and sustained patient adherence, viral suppression, and patient-physician communication and attitudes about treatment among these patients at 6 and 9 months post baseline. Methods/design This clinical trial seeks to extend these findings in public and private clinics in four urban population centers in Argentina, in which clinics (n = 6 clinics, six MDs per clinic site) are randomized to experimental (physician MI Intervention) (n = 3) or control (physician Standard of Care) (n = 3) conditions in a 3:3 ratio. Using a cluster randomized clinical trial design, the study will test the effectiveness of a physician-based MI intervention to improve and sustain retention, adherence, persistence, and viral suppression among “challenging” patients (n = 420) over 24 months. Discussion Results are anticipated to have significant public health implications for the implementation of MI to re-engage and retain patients in HIV treatment and care and improve viral suppression through high levels of medication adherence. Trial registration ClinicalTrials.gov, ID: NCT02846350. Registered on 1 July 2016. |
| first_indexed | 2024-04-12T08:30:53Z |
| format | Article |
| id | doaj.art-7bea7f6a0ff2402fa53cde24072f170b |
| institution | Directory Open Access Journal |
| issn | 1745-6215 |
| language | English |
| last_indexed | 2024-04-12T08:30:53Z |
| publishDate | 2018-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Trials |
| spelling | doaj.art-7bea7f6a0ff2402fa53cde24072f170b2022-12-22T03:40:13ZengBMCTrials1745-62152018-07-0119111910.1186/s13063-018-2758-5Physician-delivered motivational interviewing to improve adherence and retention in care among challenging HIV-infected patients in Argentina (COPA2): study protocol for a cluster randomized controlled trialOmar Sued0Isabel Cassetti1Diego Cecchini2Pedro Cahn3Lina Bofill de Murillo4Stephen M. Weiss5Lissa N. Mandell6Manasi Soni7Deborah L. Jones8Fundación HuéspedHelios SaludHelios SaludFundación HuéspedDepartment of Psychiatry and Behavioral Sciences, University of Miami Miller School of MedicineDepartment of Psychiatry and Behavioral Sciences, University of Miami Miller School of MedicineDepartment of Psychiatry and Behavioral Sciences, University of Miami Miller School of MedicineDepartment of Psychiatry and Behavioral Sciences, University of Miami Miller School of MedicineDepartment of Psychiatry and Behavioral Sciences, University of Miami Miller School of MedicineAbstract Background “Challenging” HIV-infected patients, those not retained in treatment, represent a critical focus for positive prevention, as linkage to care, early initiation of antiretroviral therapy, adherence and retention in treatment facilitate viral suppression, thus optimizing health and reducing HIV transmission. Argentina was one of the first Latin American countries to guarantee HIV prevention, diagnosis and comprehensive care services, including antiretroviral medication, which removed cost and access as barriers. Yet, dropout occurs at every stage of the HIV continuum. An estimated 110,000 individuals are HIV-infected in Argentina; of these, 70% have been diagnosed and 54% were linked to care. However, only 36% have achieved viral suppression and 31% of those diagnosed delayed entry to care. To achieve meaningful reductions in HIV infection at the community level, innovative strategies must be developed to re-engage patients. Motivational Interviewing (MI) is a patient-centered approach and has been used by therapists in Central and South America to enhance motivation and commitment in substance use and risk reduction. Our pilot feasibility study utilized culturally tailored MI in physicians to target patients not retained in treatment in public and private clinics in Buenos Aires, Argentina. Results demonstrated that a physician-based MI intervention was feasible and effective in enhanced and sustained patient adherence, viral suppression, and patient-physician communication and attitudes about treatment among these patients at 6 and 9 months post baseline. Methods/design This clinical trial seeks to extend these findings in public and private clinics in four urban population centers in Argentina, in which clinics (n = 6 clinics, six MDs per clinic site) are randomized to experimental (physician MI Intervention) (n = 3) or control (physician Standard of Care) (n = 3) conditions in a 3:3 ratio. Using a cluster randomized clinical trial design, the study will test the effectiveness of a physician-based MI intervention to improve and sustain retention, adherence, persistence, and viral suppression among “challenging” patients (n = 420) over 24 months. Discussion Results are anticipated to have significant public health implications for the implementation of MI to re-engage and retain patients in HIV treatment and care and improve viral suppression through high levels of medication adherence. Trial registration ClinicalTrials.gov, ID: NCT02846350. Registered on 1 July 2016.http://link.springer.com/article/10.1186/s13063-018-2758-5AdherenceRetentionHIVMotivational interviewingArgentinaPhysicians |
| spellingShingle | Omar Sued Isabel Cassetti Diego Cecchini Pedro Cahn Lina Bofill de Murillo Stephen M. Weiss Lissa N. Mandell Manasi Soni Deborah L. Jones Physician-delivered motivational interviewing to improve adherence and retention in care among challenging HIV-infected patients in Argentina (COPA2): study protocol for a cluster randomized controlled trial Trials Adherence Retention HIV Motivational interviewing Argentina Physicians |
| title | Physician-delivered motivational interviewing to improve adherence and retention in care among challenging HIV-infected patients in Argentina (COPA2): study protocol for a cluster randomized controlled trial |
| title_full | Physician-delivered motivational interviewing to improve adherence and retention in care among challenging HIV-infected patients in Argentina (COPA2): study protocol for a cluster randomized controlled trial |
| title_fullStr | Physician-delivered motivational interviewing to improve adherence and retention in care among challenging HIV-infected patients in Argentina (COPA2): study protocol for a cluster randomized controlled trial |
| title_full_unstemmed | Physician-delivered motivational interviewing to improve adherence and retention in care among challenging HIV-infected patients in Argentina (COPA2): study protocol for a cluster randomized controlled trial |
| title_short | Physician-delivered motivational interviewing to improve adherence and retention in care among challenging HIV-infected patients in Argentina (COPA2): study protocol for a cluster randomized controlled trial |
| title_sort | physician delivered motivational interviewing to improve adherence and retention in care among challenging hiv infected patients in argentina copa2 study protocol for a cluster randomized controlled trial |
| topic | Adherence Retention HIV Motivational interviewing Argentina Physicians |
| url | http://link.springer.com/article/10.1186/s13063-018-2758-5 |
| work_keys_str_mv | AT omarsued physiciandeliveredmotivationalinterviewingtoimproveadherenceandretentionincareamongchallenginghivinfectedpatientsinargentinacopa2studyprotocolforaclusterrandomizedcontrolledtrial AT isabelcassetti physiciandeliveredmotivationalinterviewingtoimproveadherenceandretentionincareamongchallenginghivinfectedpatientsinargentinacopa2studyprotocolforaclusterrandomizedcontrolledtrial AT diegocecchini physiciandeliveredmotivationalinterviewingtoimproveadherenceandretentionincareamongchallenginghivinfectedpatientsinargentinacopa2studyprotocolforaclusterrandomizedcontrolledtrial AT pedrocahn physiciandeliveredmotivationalinterviewingtoimproveadherenceandretentionincareamongchallenginghivinfectedpatientsinargentinacopa2studyprotocolforaclusterrandomizedcontrolledtrial AT linabofilldemurillo physiciandeliveredmotivationalinterviewingtoimproveadherenceandretentionincareamongchallenginghivinfectedpatientsinargentinacopa2studyprotocolforaclusterrandomizedcontrolledtrial AT stephenmweiss physiciandeliveredmotivationalinterviewingtoimproveadherenceandretentionincareamongchallenginghivinfectedpatientsinargentinacopa2studyprotocolforaclusterrandomizedcontrolledtrial AT lissanmandell physiciandeliveredmotivationalinterviewingtoimproveadherenceandretentionincareamongchallenginghivinfectedpatientsinargentinacopa2studyprotocolforaclusterrandomizedcontrolledtrial AT manasisoni physiciandeliveredmotivationalinterviewingtoimproveadherenceandretentionincareamongchallenginghivinfectedpatientsinargentinacopa2studyprotocolforaclusterrandomizedcontrolledtrial AT deborahljones physiciandeliveredmotivationalinterviewingtoimproveadherenceandretentionincareamongchallenginghivinfectedpatientsinargentinacopa2studyprotocolforaclusterrandomizedcontrolledtrial |