Randomized Controlled Trial Using Patient Reported Outcomes and Care Managers to Improve HIV Medication Adherence in Routine Clinical Care

Among HIV-infected patients, adherence to antiretroviral medications is one of the most
important determinants of clinical outcomes including viral suppression, viral resistance,
disease progression, and death. Unfortunately poor adherence among patients with HIV is very
common, mean levels of adherence in clinical cohorts are 60-75% or less. Alcohol, drug
abuse, and mental illness particularly depression symptoms are key predictors of poor
adherence, common among HIV-infected individuals, and important to identify and treat among
nonadherent patients. This study will examine the ability of patient reported outcomes
(PROs) and a targeted care management approach to improve clinical outcomes with a
randomized controlled trial (RCT) in routine clinical care of patients with HIV. The
investigators will determine whether healthcare delivery team notification of PROs including
antiretroviral medication adherence and barriers of adherence such as depression and
substance abuse along with tailored intervention recommendations and targeted care
management leads to improvement in both process and clinical outcomes including
patient-reported outcomes. The investigators will examine process outcomes such as use of
clinic support services, and patient outcomes such as improvement in adherence, substance
use, depression, and HIV-1 RNA levels.