Medications for Chronic HIV: Education and Collaboration (MedCHEC)

This study will examine whether a computerized, self-administered assessment of patient medication adherence and health behaviors, plus support for adherence, improves the ability of clinicians to identify adherence problems and leads to better adherence.

Antiretroviral medications are highly effective in controlling HIV, if patients adhere to the regimen. However, HIV medication adherence problems are very common, and evidence is clear that providers have great difficulty 'diagnosing' poor adherence accurately. If healthcare providers can identify patients with adherence problems, they can intervene to help patients overcome these problems and take their medications as prescribed, which can improve symptoms and quality and length of life. Both clinicians and HIV positive patients will be recruited to this study. Before each clinic visit, patients randomized to the intervention will be asked to answer questions about their medications, medication-taking behavior, and risk-factors for non-adherence on MedCHEC, a tablet touch-screen computer that generates provider and patient reports. We will give these reports to the provider and patient to assist with the clinical visit. Based on the MedCHEC-generated report, the patient may be referred to an Adherence Care Manager (ACM). The ACM will assist the patient in overcoming adherence barriers by telephone and in-clinic counseling. The study will evaluate the effects of this system on adherence and clinical care using both quantitative methods (randomized controlled trials of effects on adherence and providers' adherence estimates), and qualitative methods.

• HIV Infections
• Acquired Immunodeficiency Syndrome
• Medication Adherence

• Experimental: MedCHEC tablet computer & adherence care
  Patients assigned to the intervention answer questions about their medication, medication-taking behavior and risks for non-adherence on the MedCHEC tablet touch-screen computer, which generates provider and patient reports. Patients may be referred to an Adherence Care Manager on the basis of the reports. In addition, patients will receive standard information about adherence.
  Intervention: Behavioral: MedCHEC tablet computer and Adherence Care
• No Intervention: Adherence Information Only
  Patients assigned to the active comparator arm will receive standard information about adherence.

Inclusion Criteria:

• Over 18 years of age
• Confirmed HIV-positive
• On or newly starting antiretroviral medication for HIV
• Under treatment at one of the study sites
• Available by telephone

Exclusion Criteria:

• Clinically diagnosed by provider with significant cognitive impairment, or Mini-Mental Status Exam score less than or equal to 22
• Inability to read English
• Inability or refusal to use MedCHEC touch-screen computer
• Inability or refusal to use any form of electronic drug monitoring device (MEMS)
• Never available by telephone

• National Institute of Mental Health (NIMH)
• Department of Veterans Affairs
• VA Boston Healthcare System
• VA Greater Los Angeles Healthcare System
• San Diego State University
• Tufts University