This document summarizes preliminary findings from a study testing a computer-based tailored intervention to improve HIV medication adherence. The intervention provided personalized information, feedback, and assessment to address factors impacting adherence based on the IMB model of information, motivation, and behavioral skills. Results found the intervention significantly improved participants' information, behavioral skills, self-efficacy, and adherence as measured by percent of doses taken and correct timing, with medium to large effect sizes. While motivation and social support did not significantly change, the preliminary nature of the ongoing study and lack of a control group limit conclusions about clinical significance. Future work will explore applications for other languages, health factors, and medical conditions.

1. Development of a Computer-Based Tailored Information Application to Improve HIV-Related Treatment Adherence: Preliminary FindingsRaymond L Ownby, MD, PhDNova Southeastern UniversityFort Lauderdale FL

2. Medication adherence in HIVAdherence needed to suppress viral replication= 80-95%Typical adherence = 60-70%Viral suppression  decreased risk of infecting othersViral suppression  better clinical outcomes

3. Health literacyKnowledge, abilities, and skills required to attain a desired state of healthRelated to multiple clinical variablesDisease control (diabetes)Hospitalization (Medicare data)Death (Medicare data)Medication adherence (HIV)

4. IMB ModelInformation: How meds work, how to cope with side effectsMotivation: Social support, depressionBehavioral Skills: How to remember to take medications, cope with obstacles

5. Tailored informationPersonalizationIndividualized feedbackEnhancing perceived relevanceIncreases impact on patient behavior 10%+ increase in dietary intake of fruits 10-15% improvement in adherence in older adults treated for memory problems

6. The interventionAn overview of topicsInstructional theory

7. A Flash animation provides a preliminary overview of the virus life cycle

8. The animation emphasizes specific stages in the viral life cycleThese stages are later reviewed in discussion of how medications work

9. A key aspect of the intervention is interactivityParticipant learning is assessed with questionsIf needed, content is retaught

12. MEMSMedication Event Monitoring SystemAdherence indicesTaken (e.g.,30 pills in 30 days)Correct (e.g., 1pill/24 hours)Scheduled (e.g.,+/- 2 hours)

13. Sample (n = 110)

16. Results: LifeWindows IMB scaleInformationF= 7.141, p = 0.001 f = 0.35, a medium to large effect sizeMotivationF= 0.75, p = 0.48Behavioral SkillsF= 8.64, p< 0.001 f = 0.39, a medium to large effectBased on completers3 drop outs

17. Results: Self Efficacy, DepressionPatient-Provider InteractionF= 5.17, p = 0.007; f = 0.29, medium effectHealthcare Self-efficacy F= 11.71, p = 0.001; f = 0.39, medium to large effectDepression and Social SupportNot significant

18. Results: AdherencePercent TakenNumber of doses / monthF= 4.21, p = 0.04; f = 0.25, a medium effectPercent CorrectNumber of doses / dayF= 5.31, p = 0.02; f = 0.27, a medium effect

19. ConclusionsParticipation in the intervention is associated with improvedInformation Behavioral skills Self-reported ability to work with cliniciansHealthcare self-efficacyNot associated with improvedMotivationSocial supportMood

20. DiscussionPreliminary resultsStudy not yet completedClinical vs. statistical significanceMedium effect sizes comparable to other behavioral interventionsAdjunct to other interventionsPre-post design (no control group)

21. Future directionsOther languagesOther aspects of treatment adherenceAppointmentsDiet, exerciseOther disordersDiabetesCongestive heart failure

22. Support:Support for this study was provided by grant R21MH086491 to Dr. Ownby from the National Institute on Mental Health.

23. CollaboratorsDrenna Waldrop-Valverde, PhDJosh Caballero, PharmDRosemary Davenport, RN, MSN, ARNPRobin Jacobs, PhD