Showing papers by "Carol E. Golin published in 2004"

Brief motivational interviewing to improve adherence to antiretroviral therapy: development and qualitative pilot assessment of an intervention.

Abstract: Because successful HIV treatment requires exceptional adherence to antiretroviral therapy (ART), interventions to improve ART adherence are essential. We developed and pilot-tested an intervention to improve ART adherence, based on brief motivational interviewing (MI), which has successfully improved selected health behaviors but has not been tested for ART adherence. We administered the 15- to 30-minute MI session to 20 HIV-positive adults and assessed its usefulness and relevance. Then, we content-analyzed the session for HIV care issues and strategies most salient to patients in the MI session. During the session, all participants chose an HIV-care–related topic that they wanted to discuss, and talked about issues, barriers, and facilitators related to their topic. Most participants (70%) developed strategies to help improve their health. Questions asked after the MI session revealed that almost all (95%–100%) participants found the session useful and helpful. This theoretically based, empowering healt...

Adherence counseling practices of generalist and specialist physicians caring for people living with HIV/AIDS in North Carolina.

Abstract: CONTEXT: National guidelines recommend that practitioners assess and reinforce patient adherence when prescribing antiretroviral (ART) medications, but the extent to which physicians do this routinely is unknown.

No Evidence of an Association between Transient HIV Viremia (“Blips”) and Lower Adherence to the Antiretroviral Medication Regimen

Abstract: Background. Transient human immunodeficiency virus (HIV) viremia, a common phenomenon among patients taking antiretroviral therapy, is often attributed to lapses in adherence to the medication regimen. We investigated this relationship in a prospective observational cohort of 128 patients initiating a new regimen.Methods. A case of transient viremia was defined as an HIV RNA level of 40–1000 copies/mL (“blip”) sandwiched between 2 months of HIV RNA levels <40 copies/mL (“pre” and “post”). Adherence was most often measured with a composite adherence score (CAS), which is primarily based on electronically measured adherence. Case subjects' adherence and dose-timing was compared with (1) that of other patients (control subjects), who had undetectable virus loads for 3 consecutive months, and (2) that during periods of sustained undetectable virus loads among the case subjects themselves, if available.Results. Among the 28 case subjects, mean CAS-measured adherence did not decrease before transient viremia; adherence during the pre, blip, and post periods were 86%, 84%, and 80%, respectively. Control subjects had lower adherence levels during the corresponding 3 months (77%, 79%, and 75%, respectively; P = .046). Among the 19 patients able to serve as their own controls, CAS-measured adherence was higher during the period of transient viremia than during control periods (P = .01). Similar relationships were found when comparing only electronically measured adherence on a week-wise basis. There were no significant differences in dose-timing error between case subjects and control subjects.Conclusions. We found no evidence that transient HIV viremia is associated with decreases in adherence or differences in dose-timing. Other etiologies for transient viremia should be evaluated.

Influence of time stress and other variables on counseling by pharmacists about antiretroviral medications

Abstract: PURPOSE: The medication counseling practices of pharmacists caring for patients with HIV infection and the factors influencing their counseling behaviors regarding antiretroviral medications were examined. METHODS: A questionnaire was mailed in February 2000 to pharmacist-managers of 573 ambulatory care pharmacies providing medications to beneficiaries of the North Carolina AIDS Drug Assistance Program. The frequency of and attitudes about adherence counseling for patients with HIV infection; the time allocated, spent, and needed to provide high-quality care to these patients; and pharmacists' time pressure and time stress were measured. RESULTS: Of the 573 questionnaires mailed, 440 (77%) were usable. Fifty-nine percent of pharmacists reported that they did not have enough time to provide adherence counseling to patients receiving antiretroviral medications, and 45% reported that most of their patients did not receive such counseling. Time-stressed pharmacists were significantly less likely to perform 12 of 22 counseling behaviors, including discussing adverse effects (13% versus 24%, p < 0.0089), drug interactions (13% versus 31%, p < 0.0001), and what to do if a dose is missed (8% versus 23%, p < 0.0001). Multivariate analysis revealed that time stress, perceived skill and interest in adherence counseling, and job satisfaction were significantly associated with the counseling index. CONCLUSION: Time pressure and other barriers appeared to limit the care that some pharmacists offered to patients with HIV infection. Pharmacist age, job satisfaction, and perceived skill and interest in adherence counseling influenced the comprehensiveness of the counseling pharmacists provided for patients receiving antiretroviral medications.

Availability of and access to medical services among HIV-infected inmates incarcerated in North Carolina county jails.

Abstract: This study assessed human immunodeficiency virus (HIV)-related services in county jails and staff perceptions of HIV-infected inmates and their care. A statewide telephone questionnaire was administered to detention officers and health care workers providing medical services in North Carolina jails. Eighty-five percent of participating facilities employed one or more on-site medical personnel, including physicians (51%), physician assistants (14%), and nurses (71%). Only 25% of jails tested more than one inmate for HIV per month. In 75% of jails, initial medical screening was performed in a common area. Officers administered medical screening forms at 93% of jails and distributed medications at 81%. Ninety-three percent of officers and 94% of medical staff agreed with this statement: "If an inmate is taking medications in jail, other inmates will know about it." Overall, our data indicate that few North Carolina jail inmates are tested for HIV. Greater protection of confidentiality may improve screening and treatment of HIV-infected inmates.