Published online March 12, 2007
PEDIATRICS Vol. 119 No. 4 April 2007, pp. e893-e899 (doi:10.1542/peds.2006-1488)
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ARTICLE

Efficacy of a Pill-Swallowing Training Intervention to Improve Antiretroviral Medication Adherence in Pediatric Patients With HIV/AIDS

Patricia A. Garvie, PhDa,b, Shelly Lensing, MSc and Shesh N. Rai, PhDc

a Division of Behavioral Medicine
c Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
b Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee

OBJECTIVE. We aimed to retrospectively assess the efficacy of pill-swallowing training provided as a clinical intervention to referred pediatric patients with HIV in relation to improved adherence and subsequent related health outcomes. The primary goal of this study was to demonstrate participation in pill-swallowing training is associated with improved medication adherence as documented by routine pharmacy pill counts. Secondary objectives were to assess corresponding improvements in clinically observed biologic indicators of adherence, specifically, immunologic functioning (CD4+ T-cell%) and viral load, over time.

PATIENTS AND METHODS. A retrospective chart review of 23 pediatric patients with HIV aged 4 to 21 years who were clinically referred for pill-swallowing training by an experienced pediatric psychologist for either noted difficulties with currently prescribed antiretroviral regimens and/or desire to change the child's regimen/formulary. Patient demographics, reason(s) for pill-swallowing training referral, number of pill-swallowing training sessions required to attain success, adherence, CD4+ T-cell%, and viral load were abstracted at baseline and at ~3 and 6 months posttraining.

RESULTS. Modal number of sessions required to acquire the pill-swallowing skill was 1 session. Younger children (aged 4–5 years) required a median of 2 training sessions, while older children required ≥3 sessions. A significant improvement in adherence from baseline to 6 months post–pill-swallowing training completion was observed, as were significant related improvements in CD4+ T-cell% and viral load.

CONCLUSIONS. Participation in pill-swallowing training related to improved medication adherence at 6 months posttraining. Subsequent improvements in related CD4+ T-cell% and viral load were noted over time, most significantly at 6 months postintervention. These preliminary findings provide justification for additional study via a prospective, randomized, controlled clinical trial. Pill-swallowing training potentially is a successful time-limited, cost-effective intervention to improve adherence to antiretroviral therapies, and thus medical status, in children with HIV.

Key Words: pediatric HIV • pill swallowing • adherence • health outcomes

Abbreviations: HAART—highly active antiretroviral therapy • PST—pill-swallowing training • VL—viral load

Accepted Oct 18, 2006.