Dialogue Education In Improving Adherence To Antiviral Treatment In HIV/AIDS Patients

Objective:To validate the feasibility and applicability of Freire’s Dialogue education in improving adherence to antiretroviral therapy (ART) adherence interventions among HIV/AIDS patients; to explore the effect of Dialogue Education to improve ART adherence, medication knowledge and treatment outcomes.Methods:This study was an experimental study. The target population of this study was patients newly receiving ART whose medication adherence is less than90%. This study lasted from July5,2010to February20,2012,for a period of19months. Changsha and Hengyang were selected as study sites.A total of114patients were randomly divided into two groups,57in the experimental group and57in the control group.Subjects in the experimental group were given a six months home visiting intervention.The intervention model was designed based on Freire’s Dialogue Education, combining with the the conceptual framework of Simoni compliance research project and the Chinese factors influencing medication adherence. Interventions were implemented by an experienced nurses and a HIV Peer Educator. Data collection methods included questionnaires, laboratory tests, review of medical records. During the baseline study and follow-up data collection, measurement tools included:general information questionnaire to collect patient demographic information and disease-related information; ART adherence questionnaire; medication knowledge questionnaire to evaluate patient’s knowledge of medication; Medical Outcomes Study HIV Health Survey (MOS-HIV) to evaluate quality of life; laboratory examination to test viral load and CD4+T lymphocytes.Results:(1) Among the114patients taken in study, five patients died, six patients lost, and103patients completed the study.(2)After the intervention, the average adherence of experimental group was higher than that of the control group (98%vs86%, P=0.001).(3) After the intervention, medication knowledge score of experimental group was higher than the control group (z=3.160, P=0.002).(4) By repeated measures ANOVA:there were significant main effects of intervention on five domians of health perception, pain, emotional function, energy, quality of life and total score of physiological function of the, total score of psychological functions.(5) After the intervention, differences of CD4+T lymphocyte count and viral load are not significant in two groups (z=0.125, P=0.879and z=0.621, P=0.535).(6)By Kaplan Meier analysis:survival time was no significant difference in two groups after interventions, with the average survival time of18months in the control group and19months in the experimental group; the difference of follow-up time was significant in Two groups (P=0.010), the average follow-up time was16months in the control group and19months in the experimental group.Conclusion:(1) The intervention model based on Freire’s Dialogical Education is effective and feasible, which significantly improve the ART adherece in HIV/AIDS patients.(2) Dialogue education significantly increased medication knowledge of HIV/AIDS patients.(3) Dialogue Education improved health perception,pain, emotional functioning, energy, quality of life,physiological function and psychological function of HIV/AIDS patients.(4) The intervention had little effect in laboratory markers of viral load and CD4+T lymphocyte count within six months.(5) Dialogue Education increased follow-up time in patients newly receiving ART.