Objective: To evaluate the efficacy of a program designed to improve adherence to antiretroviral therapy among patients with poor adherence. Methods: A randomized intervention trial was conducted among 90 HIV-positive patients experiencing treatment failure as a result of noncompliance with their medication regimen. Eligible participants were randomly assigned to an adherence case management intervention with monetary reinforcement (CM) or to a standard of care group (SC). The CM participants met regularly with a treatment advocate for individualized adherence support. Efficacy was measured in terms of reductions in viral load and improvements in immune function at weeks 12, 24, and 48. Results: After 48 weeks, 55% (n = 26) of those in the CM achieved at least a 1-log10 drop in viral load as compared to 28% (n = 12) in the SC group (P = .0089). Furthermore, the mean CD4 count was 209 cells/mm3 for the CM group as compared to 150 cells/mm3 in the SC group (P = .0333). Based on logistic regression analysis, being in the CM was an independent predictor of reduction in viral load (odds ratio = 2.49; P = .0514). Conclusion: The individualized adherence intervention is feasible and effective in reducing viral load and improving immune function.
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