The adolescent medicine HIV/AIDS research networkThe TREAT (therapeutic regimens enhancing adherence in teens) program: theory and preliminary results
Section snippets
Background
Hippocrates noted that patients often lie when they state that they have taken certain medicines to please the clinician or avoid disapproval [1]. From his time until the issue of therapeutic adherence was rediscovered 30 years ago [2], the nature of the physician-patient relationship, individual patient situations and characteristics, the vicissitudes of human behavior, and the impact of disease itself were all factors of little note given our steadfast faith in the authority of medical
Development
TREAT is an adolescent-focused, multifaceted program, based on the SOC Model, to promote optimal, long term adherence to HAART. The choice of the SOC Model as a base for the intervention design was supported by results from three focus group exercises with HIV infected youth who have struggled with treatment decisions, and one focus group exercise with the REACH study coordinators who had been deeply involved in their care. Among other findings, focus group exercises revealed that the
Subject groups
There were 288 HIV infected subjects enrolled in the REACH Study at the time that the TREAT Program became available. Slightly over one-half n = 147, 51%) had been prescribed HAART and 10% (n = 29) had been prescribed non-HAART regimens, leaving 39% (n = 112) treatment naive. This last group was the target population of the TREAT Program. Nonetheless, study coordinators were encouraged to use TREAT with subjects in the other two groups if they judged it to be useful. In all, study coordinators
Discussion
For most HIV infected youth, treatment adherence is a profound challenge. HIV infection and its treatment differ in significant ways from chronic diseases, which are often symptomatic before treatment as well as when medications are delayed or skipped, thus providing built-in positive and negative reinforcements for different levels of adherence. In such cases trial and error can be instructive (though not always without risk), with each failure accompanied by consequences and learning, and
Summary
The TREAT Program has been developed to address the particular challenges of adherence to HAART confronting HIV infected youth. It is designed as a multifaceted, adolescent-focused set of interventions based on the SOC model. Although the available data did not permit an assessment of the program’s ultimate effectiveness in promoting long term adherence to HAART among HIV infected youth, it was judged to be well-received by the participating youth. The staging tool appeared to be able to
Acknowledgements
The opinions expressed in this paper are those of the authors alone and do not necessarily represent the opinions of the agencies or institutions with which they are affiliated. The TREAT Program was developed with funding from the Health Resources and Services Administration and NICHD N01-HD-3-3162. For more information, contact the author.
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