Physical demonstration of treatment mode-of-action helps patients with HIV improve their health

Today, thanks to the availability of effective treatments, people with HIV are living lifespans that are comparable with those of non-infected persons. But there is a trick: patients with HIV need to stay on treatment, as prescribed, for their entire lives.

When patients do not take their treatment as prescribed, there are no immediate consequences, rather the negative effects on health are long term and insidious.

Professionals caring for people living with HIV know that organizing one’s life around the medication is no easy task, as it requires not only motivation, but also information and skills. Many strategies have already been tried in helping patients adhere to their treatments, including counselling, SMS reminders and smartphone technologies and even the more extreme approach: supervising patients while taking each dose. No approach has been proven bullet proof, that is why the search for a better way to help patients with adherence continues.

Recently, health psychologists have shown that active visualization of treatment mode-of-action in the body might prove a useful approach. Active visualization uses dynamic visual representations, such as animation or physical demonstrations, and can be delivered in a variety of ways, such as on smartphones, computers or even on ad-hoc created devices. The advantage of this approach is that it enables presenting information about treatment in a new, engaging way.

A team of researchers has built a body shaped transparent plastic container that was filled with a basic pink solution. When an aspirin tablet was introduced (mimicking the moment when the patient was taking his HIV medication), the inside liquid changed color from pink to clear, representing how the medication was controlling for HIV multiplication. For the following dose, to show that the virus is still in the body, the pink solution is added again, and the process is repeated. A short video with the demonstration is available here.

The effectiveness of the device in helping patients take their treatment was tested in two clinics in Western Cape, South Africa. 111 adult patients who have been diagnosed and treated for approximately 7 years, were distributed randomly in two groups, one receiving the active visualization demonstration and the other one care as usual (meeting with physician, counselling and discussion about causes of issues with treatment). Psychologists collected information about HIV viral load before and after the intervention (the lower the viral load, the better controlled the infection). They also asked patients to fill questionnaires asking about various psychological aspects, such as beliefs about medication, motivation to take the treatment, perceptions of seriousness of illness, difficulties with taking treatment and depression levels. Approximately 8 months after the demonstration viral load was measured again. There were improvements in both groups across time. But it was observed that more patients who participated in the demonstration session had lower viral load levels compared with the group only receiving usual care (61.9% vs 38.1%). Other aspects related to their beliefs and motivation did not change after the intervention, thus suggesting that after years of treatment, patients have progressively expanded their awareness on the necessity of medication and seriousness of illness and supplemental improvement might not be likely. 

Participants liked the demonstration, considering it acceptable, easy to understand and motivating. The device has several advantages over more modern technologies: it is cheap, portable and easy to use, making it a better fit for resource limited settings.

Despite the promising results, a clear mechanism of action regarding the relationship between the active visualization device and the clinical changes observed, was not identified by this study. It is possible that the novelty of how the health information was delivered, to increase the salience of some key treatment information and the overall motivation.

Although this work is still in progress, it has the potential to be easily replicated and used in day to day care of patients in many settings, including remote populations and younger patients.

References:

Jones, A.S.K. & Petrie, K.J. AIDS Behav (2017) 21: 335. https://doi.org/10.1007/s10461-016-1611-7

Jones, A.S.K., Coetzee, B., Kagee, A. et al. AIDS Behav (2019) 23: 2121. https://doi.org/10.1007/s10461-018-2292-1