Honghong Wang

Aims and objectives.  This study aimed to examine the effects of nurse‐delivered home visits combined with telephone intervention on medication adherence, and quality of life in HIV‐infected heroin users.Background.  Drug use is consistently reported as a risk factor for medication non‐adherence in HIV‐infected people.Design.  An experimental, pretests and post‐tests, design was used: baseline and at eight months.Methods.  A sample of 116 participants was recruited from three antiretroviral treatment sites, and 98 participants completed the study. They were randomly assigned to two groups: 58 in the experimental group and 58 in the control group. The experimental group received nurse‐delivered home visits combined with telephone intervention over eight months, while the control group only received routine care. The questionnaire of Community Programs for Clinical Research on AIDS (CPCRA) Antiretroviral Medication Self‐Report was used to assess levels of adherence, while quality of life and depression were evaluated using Chinese versions of World Health Organization Quality of Life Instrument – Abbreviated version (WHOQOL‐BREF) and Self‐rating Depression Scale, respectively. Data were obtained at baseline and eight months.Results.  At the end of eight months, participants in the experimental group were more likely to report taking 100% of pills (Fisher’s exact = 14·3, p = 0·0001) and taking pills on time (Fisher’s exact = 18·64, p = 0·0001) than those in the control group. There were significant effects of intervention in physical (F = 10·47, p = 0·002), psychological (F = 9·41, p = 0·003), social (F = 4·09, p = 0·046) and environmental (F = 4·80, p = 0·031) domains of WHOQOL and depression (F = 5·58, p = 0·02).Conclusions.  Home visits and telephone calls are effective in promoting adherence to antiretroviral treatment and in improving the participants’ quality of life and depressive symptoms in HIV‐infected heroin users.Relevance to clinical practice.  It is important for nurses to recognise the issues of non‐adherence to antiretroviral treatment in heroin users. Besides standard care, nurses should consider conducting home visits and telephone calls to ensure better health outcome of antiretroviral treatment in this population.

This study aimed to assess levels of ART adherence and to examine the relationship between adherence and treatment outcomes. A longitudinal study in Hunan and Hubei provinces used the CPCRA Antiretroviral Medication Self-Report and a 7-day Visual Analogue Scale to assess levels of adherence, while quality of life was evaluated using SF-36. CD4 cell count and the number, duration, and cost of hospitalizations were collected from participant medical records. Measurements were obtained at baseline, month 3, and month 6. A total of 113 participants enrolled and 98 completed the study. The mean level of adherence was 91%, 89%, and 88% at baseline and at 3 and 6 months, respectively. Of participants, 54/98 (58%) reported taking all doses at all three interviews and were classified as consistent adherers (CA). CAs had better physical function (p = 0.001), general health (p = 0.009), vitality (p = 0.016), social functioning (p = 0.001), and mental health (p = 0.023), and presented a higher CD4 cell count (p = 0.028). CAs also had fewer hospital admissions and readmissions (p = 0.005), shorter hospital stays (p = 0.005), and lower hospital expenses (p = 0.006). Consistent adherence is associated with better outcomes including improved quality of life, higher CD4 counts, and lower health care costs.