Nursing study looks for ways to improve treatment for men with HIV

Three nursing students at San Francisco State University have found that two very simple interventions — treatment for depression and regular text messages and cell phone calls — can greatly improve the rate of anti-retroviral therapy adherence among men who have HIV, the virus that causes AIDS.

The findings came out of a research- and evidence-based class that every student in the School of Nursing takes to learn how to analyze and write for scholarly publications. Students Inga Knudson, Stephanie Payne and Robbie Rodriguez did a meta-analysis of six studies that looked at anti-retroviral therapy adherence in the United States among men who have sex with men. The studies included systematic reviews, meta-analyses, randomized control trials and pre- and post-intervention studies, with the number of participants ranging from several dozen to more than 1,000.

More than one million Americans have HIV — the majority of whom are men who have sex with men. Antiretroviral therapy is the primary means of treating HIV. It uses one drug or a combination of medications to slow the rate at which HIV reproduces within the body. The therapy extends the lives of people with HIV and reduces the risk of transmitting the virus.

“There’s a rigorous schedule,” Payne said. “You have to take these medications every day.”

People with HIV often blame non-adherence on forgetfulness, busyness or sleeping through the scheduled time for taking their medication. Other barriers include poverty, lack of health insurance and medication side effects. Depression is also a factor — 40 percent of those living with HIV also have depression, Knudson said. But because more than 90 percent of Americans have cell phones, text messages and phone calls are a great way to reach out to those with HIV for medication reminders, as well as for offering support.

“So [a text message] may ask them, ‘How are you feeling today? How is your stress?’” Payne said. “Those are more effective than just, ‘Take your meds.’”

Frequently, people living with HIV are already deeply marginalized and are reluctant to seek help, Knudson said.

“We’re talking about racial minorities, sexual minorities or people who use drugs. They’re already facing a lot of stigma,” she said. “So going to see a doctor is one of the last things on your list when you’ve been kicked out of your house.”

The analysis found higher rates of medication adherence, as well as lower viral counts, when health workers reached out to anti-retroviral therapy participants. The students recommended that participants be screened for depression and treated accordingly.

The analysis is particularly timely because of the number of new infections occurring among men who have sex with men, Assistant Professor of Nursing Therese Doan said. In the U.S., this group makes up 55 percent of HIV-positive people and 67 percent of new infections, according to the Centers for Disease Control and Prevention.

Doan said one follow-up to the analysis could be a collaboration with a city health department to collect data on anti-retroviral adherence and pilot test one of the interventions — either treatment for depression or contact by phone.

The students recommended that future researchers conduct larger studies with larger sample sizes. They also suggested studies look at the effectiveness of cognitive behavior therapy, as well as a standardized text message system. Payne and Knudson plan to present their findings this month at the International Nursing Research and Leadership Conference in Vancouver, British Columbia.