Readiness for Adherence with Peer Support Components: A Model to Improve Adherence to Anti Retroviral Therapy

Bipasha Biswas
George Warren Brown School of Social Work
Washington University in St. Louis
1 Brookings Drive
Saint Louis MO 63130
United States
Phone: 314-454-0303
Email: bbiswas@gwbmail.wustl.edu
 
Linda Mundy
Department of Internal Medicine
Division of Infectious Diseases
Washington University in St. Louis School of Medicine
Saint Louis MO 63110
United States
Phone: 314-454-8216
Email: lmundy@im.wustl.edu
 
PURPOSE: Anti retroviral therapy (ART) has the potential of converting Human Immunodeficiency Virus-1 (HIV-1) infection from “an untreatable terminal illness to a long-term, chronic illness” (Balter, 1996).  However, strict adherence to the regimen is required to achieve undetected viral levels in blood serum.  This paper presents findings from an HIV/AIDS care and support unit providing adherence support services, utilizing peer support in the context of Trans Theoretical Model (TTM) - assessing readiness for adherence.  TTM describes behaviour change as a gradual process through definite steps.  The peers act as catalysts in helping individuals progress from one stage to the other based on readiness for adherence.

METHODS:  Assessment of CD4 and viral load along stages of change and decisional balance for 145 participants was conducted at baseline and at twelve months in an adherence support study.  72-hour self report measured adherence among the participants.  Viral Load and CD4 data obtained from clinic charts assessed viral suppression and immune system recovery respectively.

RESULTS:  Preliminary findings reveal an increase in delta CD4 at twelve months, suggesting improved immune status for participants in the adherence support study group.  An ANOVA comparing this group with others who did not receive TTM based peer support services at the clinic revealed significant mean differences in delta CD4s.

IMPLICATIONS FOR PRACTICE:  Adherence support services provided by the stage based TTM model with peer components is effective in improving adherence to ART.  It is possible to replicate and apply this model at other HIV/AIDS care settings and has the potential of improving quality of life with HIV infection, reducing development and transmission of multiple drug resistant virus, and subsequently protecting the health of the public in general.