Adherence Intervention for People With Low-literacy

Adherence to antiretroviral medications is necessary to achieve sufficient HIV suppression
and nonadherence can lead to the development of treatment resistant genetic variants of HIV.
Research has demonstrated that people living with HIV/AIDS who have low-levels of health
literacy experience greater treatment non-adherence than their higher-literacy counterparts.
Interventions are urgently needed to improve treatment adherence in people with poor
literacy skills. This application proposes to test a theory based behavioral intervention
for improving HIV treatment adherence in people living with HIV/AIDS who have low-literacy
skills. Grounded in the Information - Motivation - Behavioral Skills (IMB) model of health
behavior change, the experimental intervention has been tailored for people with low-levels
of health literacy and has been pilot tested in preliminary intervention development
research. The intervention is delivered in three one-on-one counseling sessions and one
maintenance-focused booster session. The intervention will be conducted in a community care
setting in Atlanta. Men and women will be recruited from a AIDS services and infectious
disease clinics throughout the Atlanta metropolitan area. Following screening, informed
consent and baseline assessments participants will be randomly assigned to receive one of
three conditions: (a) Theory-based literacy tailored treatment adherence intervention; (b)
standard of care non-tailored time-matched adherence counseling intervention; (c)
noncontaminating time-matched attention control intervention. Participants will be followed
for 12-months observation. Assessments will include measures of information, motivation, and
behavioral skills pertaining to HIV treatment adherence, self-report and objective
medication adherence, and viral load. The study will test the hypothesis that a theory-based
HIV treatment adherence intervention that is tailored for people with low-literacy will
improve HIV treatment adherence and health relative to the standard and attention control
conditions. The study will also examine the influence of IMB theoretical constructs on
intervention outcomes. The intervention under investigation will be among the first to
address treatment adherence among people with poor literacy skills. If shown effective, the
intervention model will be ready for immediate dissemination to clinical and community
adherence enhancement services for people living with HIV-AIDS.