Improving Antiretroviral Medication Adherence Among HIV-infected Youth

Aims:

1. To conduct a randomized controlled pilot test of a behavioral adherence intervention to
improve medication adherence among HIV-infected youth aged 13-24. Feasibility of all
study procedures and participant acceptability will be assessed.

2. To explore whether the intervention leads to improved medication adherence among youth
who receive the intervention, compared to a control group of youth who do not.

40 HIV-infected adolescents will be recruited for a RCT pilot of the Positive STEPS
intervention at Fenway Health and Children's Hospital Boston. Participants will be
randomized into one of two arms (half and half). Randomization for all participants will
occur after the beginning of the week 2 study visit. The duration of the study is 3 months

Randomization:

The investigators will conduct block randomization based on two categories of electronic
adherence: 85% or above versus < 85%. All participants will have exhibited some
non-adherence in order to be eligible for the study, although they may vary in the extent of
non-adherence. Because insufficient information is known about the range of non-adherence in
the population to determine the most valid non-adherence cut-off points, the investigators
may need to reconsider adherence categories over the course of the pilot study. The
investigators will regularly examine the data to determine whether finer adherence
categories are needed, and the investigators will adjust the categories if such a
determination is made.

Intervention arm:

- Participants will receive one on one Positive STEPS counseling sessions (~1 hour
sessions per week for 5 weeks).

- Participants will receive motivational reminders to take medications sent via text
message to their cell phones

- Participants will receive the Medication Event Monitoring Systems (MEMS) pill cap
monitoring device to measure antiretroviral medication adherence.

Comparison condition arm:

• Participants will receive the Medication Event Monitoring Systems (MEMS) pill cap
monitoring device to measure antiretroviral medication adherence.

Inclusion Criteria:

- Age 13 to 24 years

- HIV-infected

- Currently taking antiretroviral therapy or prescribed medication for HIV

- Self-reported difficulties adhering to HIV medications in the past 3 months (i.e.,
<95% compliant)

- If 18-24: Willing and able to provide informed consent

- If 13-17: Parent/guardian willing and able to provide parental permission and
participant willing and able to provide assent

- Willing to attend all study visits

Exclusion Criteria:

- If 18-24:Unwilling or unable to provide informed consent

- If 13-17: Parent/guardian unwilling or unable to provide parental permission and
participant willing and able to provide assent

- Has severe mental illness requiring immediate treatment (e.g. active psychotic
episode) or a mental illness that would limit your ability to participate (e.g.
dementia)

- Has severe cognitive limitation that would limit your ability to comprehend the
informed consent or assent (see Decisional Capacity Determination SOP)

- Unwilling to attend all study visits