Adherence Strategies

Researchers study use of the 'MATI' for improving AIDS drug adherence

Early data confirm tool's usefulness

Investigators have found that an adherence tool that addresses multiple factors contributing to adherence difficulties can assist with better adherence.

The Medication Adherence Training Intervention (MATI) is a newly-invented tool that prepares patients for adherence by incorporating medication adherence education, the patient's history and medication experiences, with motivation and empowerment interventions, says Shvawn McPherson-Baker, PharmD, MPH, a research associate in the division of hepatology at the University of Miami School of Medicine in Miami, FL.

"We developed the MATI along the context of clinical pharmacy, clinical medication, and clinical psychology, interfacing the three of them to come up with an approach to patient care," Baker says. "We looked at how to best incorporate the patient's abilities with our abilities."

One aspect to the MATI that's important is how it is designed to be a nonjudgmental tool that doesn't admonish patients for their poor adherence habits, Baker notes.

"The approach is ' Let's take off the white coat and work on this together,'" Baker says. "Let's see if there's a readiness for medication adherence and provide education on that."

Often, clinicians see HIV patients who say they're taking their medication appropriately, but their lab work suggests otherwise, Baker says.

"I say to the patients, 'Don't tell me what you think I want to hear; tell me what you're doing, because you're saying one thing, but your numbers don't match,'" Baker says. "Then patients will say the medications make them sick or that they don't want to take them."

This is where the MATI comes in handy. It provides a checklist of items to cover when assessing a patient's adherence, and it helps the clinician find out what the patient's approach is to medication, Baker says.

"We go down a list of things we need to cover, like different parts of medication, medication history, experiences with medications, beliefs," Baker says. "We try to find out where patients are coming from in their approach to medication and what they believe about treatment."

For example, the MATI checklist, which is included in a March 2005 article published in Behavior Modification, includes the following:

  • "Assess for basic knowledge about HIV; What is HIV? What do you know about HIV?"1
  • "Understand drug 'cocktails' and how they affect the virus; What do you know or what have you heard about the drug cocktails?"1
  • "Assess knowledge of medication strategies (compliance or adherence); If 100% is all the time, and 0% is not at all, during the past month, how much of the time have you taken all of your HIV and AIDS medicines?"1
  • "Myths and rumors about HIV medications; What have you heard about antiviral medications? Protease inhibitors?"1

"We had a woman in the clinic who just recently came out of a treatment program for crack cocaine," Baker says, offering one case study example of how the tool is used.

"She's in her 40s, has two or three children, but most are grown," Baker notes. "She's functioning as her own entity and has a level of independence, but has never been treated for HIV."

"She found out she was HIV positive, and she has been clean from drugs for three months and is comfortable with being clean," Baker adds.

The woman's physician had discussed the possibility of her starting medications and had referred her to Baker for an assessment, but the prescription hadn't been written.

"The doctor wanted me to talk with her about the regimen they anticipate putting her on," Baker says. "They wanted me to discuss what it entails, what the side effects are, what she can expect from therapy, and when she can expect it from therapy."

Baker discussed these issues with the patient and asked whether she was comfortable with the information, and she said she was.

So Baker followed the MATI checklist and discussed other issues with the patient, including the stigma of being HIV positive, what her goals were, what her concerns were, and what her expectations were about treatment.

During this discussion, Baker was able to dispel some myths the woman believed, such as thinking that taking AZT might cause her skin to darken, which would let people know she was HIV positive, Baker says.

The woman recalled that a neighbor some years earlier had taken AZT, and then his skin got dark, and he looked like someone with AIDS, Baker adds.

"That patient was diagnosed with HIV infection at a time when we didn't have a lot of medications other than AZT, and that drug was reserved for people at the end-stage," Baker explains. "So this guy probably was very sick, and she believed that was the picture of HIV."

Baker also explained how much HIV infection has changed in recent years because of the multiple medications available for treatment.

"I let her know HIV infection is not a death sentence, and people can live relatively normal lives," Baker says.

While the woman's physician and other clinicians had already told her this, she needed the information repeated, Baker says.

"My role in the medication clinic is to do that with patients, because it's good to have another person who can reinforce the information," Baker says. "I was introduced as the pharmacist who was going to talk with her about medications."

The session worked.

"So she went home, thought about it, and came back, saying, 'I'm ready; I thought about what you said, and I want to live for my grandchildren.'"

The woman acknowledged that she knew she wouldn't feel good for a few weeks after initiating therapy, but she was ready to take charge of her life, Baker says.

"She's been successful, has gained weight, and is doing great," Baker adds.

Baker helped to develop the MATI as a way to give other clinicians a tool to use when discussing antiretroviral treatment with patients, so they might obtain optimal adherence.

"It's a way of finding an approach to patient counseling and bringing in the patient as part of the team," Baker says. "The goal is for patients to synthesize all of this information and to make sure they understand what their responsibilities and roles are and what they are to expect from their treatment."

Clinicians using the tool will need to have some medication knowledge base because they'll have to discuss how the medications work, what the side effects are, and answer questions in detail, Baker says.

"Inevitably these questions come up, and one of the things that helps to build that foundation of trust is patient knowing you know what you're talking about, and if they ask you a question that you can give them an honest answer," Baker adds.

So while it would help to have pharmacists use the tool with patients, other disciplines also could do the job, including social workers, nurse practitioners, physician assistants, and physicians, Baker says.

Reference:

  1. McPherson-Baker S, et al. Development and Implementation of a Medication Adherence Training Instrument for Persons Living with HIV: The MATI. Behav Modif. 2005;29:286-317.