Abstract
Background: Poor medication adherence is still the main cause of antiretroviral therapy (ART) failure among people living with HIV/AIDS (PLWHA). Effective behavioral interventions are needed to improve HIV awareness and medication adherence. Methods: In this retrospective cohort study, we assessed the effect of problem-based learning (PBL) approaches to HIV-related education and adherence outcomes among PLWHA and a college student sample. In our study, compared with 309 demography-matched control participants using conventional counseling methods (109 PLWHA and 200 college students), 321 subjects (111 PLWHA and 210 college students) chose to learn HIV-related knowledge via PBL-integrated methods. Co-primary outcomes were self-administered questionnaire after HIV-related education by all participants and self-reported medication adherence by newly diagnosed PLWHA, measured in terms of the number of missed doses in the past week at each of the seven visits during a 1-year period. Multivariate regression models adjusting different covariates were used to test the robustness of HIV awareness and adherence association. Mediation model was used to investigate the relationship among PBL training, awareness of HIV, and ART adherence. Results: The knowledge scores of participants in the PBL group were higher than those in the controls (P = 0.001), especially the subgroup of newly diagnosed PLWHA in the PBL group (P = 0.001). The HIV-related health scores of the PBL college students were also higher than those of subjects exposed to conventional education (P < 0.001). There was no significant difference between the two by newly diagnosed PLWHA groups in the number of missed doses during the past week at each visit except at the first follow-up visit (P = 0.018). The indirect effect of PBL-integrated education on ART adherence at the 2-week visit through HIV awareness had a point estimate of 0.0349 and a 95% bias-corrected bootstrap confidence interval of 0.0061∼0.0874 in newly diagnosed PLWHA. Conclusions: PLWHA and college students using PBL showed improved awareness of HIV and higher levels of recent ART adherence; however, there was no change in long-term ART adherence in newly diagnosed PLWHA.
Highlights
The mortality and mobility of people living with HIV/AIDS (PLWHA) have decreased tremendously with the advent of combined antiretroviral therapy (ART) (Gulick et al, 1997; Hammer et al, 1997)
We integrated Problem-based learning (PBL) into conventional health education programs for PLWHA and the general populations, and we evaluated the effectiveness of PBL in promoting HIV awareness and ART adherence among PLWHA participants who were ready for ART initiation
PBL, problem-based learning; PLWHA, people living with HIV/AIDS. aThe data showing normal distribution using Shapiro–Wilk test are represented by the average ± standard deviation. bNumber of subjects in each item
Summary
The mortality and mobility of people living with HIV/AIDS (PLWHA) have decreased tremendously with the advent of combined antiretroviral therapy (ART) (Gulick et al, 1997; Hammer et al, 1997). ART-experienced PLWHA may still exhibit poor compliance and adherence (Bezabhe et al, 2016), which are still the main cause of treatment failure (Paterson et al, 2000; Martin et al, 2008) because of cumulative ART-related toxicity (Song et al, 2018). To prevent poor ART adherence (Ortego et al, 2011), more effective interventions targeting ART-naive PLWHA patients are needed to improve the awareness of ART-related side effects and toxicity. Poor medication adherence is still the main cause of antiretroviral therapy (ART) failure among people living with HIV/AIDS (PLWHA). Effective behavioral interventions are needed to improve HIV awareness and medication adherence
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