%0 Journal Article %J Cogn Behav Pract %D 2013 %T The Chinese Life-Steps Program: A Cultural Adaptation of a Cognitive-Behavioral Intervention to Enhance HIV Medication Adherence. %A Shiu, Cheng-Shi %A Chen, Wei-Ti %A Simoni, Jane %A Fredriksen-Goldsen, Karen %A Zhang, Fujie %A Zhou, Hongxin %X

China is considered to be the new frontier of the global AIDS pandemic. Although effective treatment for HIV is becoming widely available in China, adherence to treatment remains a challenge. This study aimed to adapt an intervention promoting HIV-medication adherence-favorably evaluated in the West-for Chinese HIV-positive patients. The adaptation process was theory-driven and covered several key issues of cultural adaptation. We considered the importance of interpersonal relationships and family in China and cultural notions of health. Using an evidence-based treatment protocol originally designed for Western HIV-positive patients, we developed an 11-step Chinese Life-Steps program with an additional culture-specific intervention option. We describe in detail how the cultural elements were incorporated into the intervention and put into practice at each stage. Clinical considerations are also outlined and followed by two case examples that are provided to illustrate our application of the intervention. Finally, we discuss practical and research issues and limitations emerging from our field experiments in a HIV clinic in Beijing. The intervention was tailored to address both universal and culturally specific barriers to adherence and is readily applicable to generalized clinical settings. This evidence-based intervention provides a case example of the process of adapting behavioral interventions to culturally diverse communities with limited resources.

%B Cogn Behav Pract %V 20 %P 202-212 %8 2013 May %G eng %N 2 %R 10.1016/j.cbpra.2012.05.005 %0 Journal Article %J AIDS Behav %D 2011 %T A preliminary randomized controlled trial of a nurse-delivered medication adherence intervention among HIV-positive outpatients initiating antiretroviral therapy in Beijing, China. %A Simoni, Jane M %A Chen, Wei-Ti %A Huh, David %A Fredriksen-Goldsen, Karen I %A Pearson, Cynthia %A Zhao, Hongxin %A Shiu, Cheng-Shi %A Wang, Xin %A Zhang, Fujie %K Adult %K Anti-HIV Agents %K CD4 Lymphocyte Count %K China %K Counseling %K Cross-Sectional Studies %K Drug Monitoring %K Electronics, Medical %K Female %K HIV Infections %K HIV-1 %K Humans %K Male %K Medication Adherence %K Middle Aged %K Nurses %K Outpatients %K RNA, Viral %K Treatment Outcome %K Viral Load %K Young Adult %X

We evaluated a nurse-delivered adherence intervention in a preliminary randomized controlled trial among 70 HIV-positive outpatients initiating antiretroviral therapy (ART) in Beijing, China. In both arms, participants received a 30-min educational session, a pillbox, and a referral to a peer support group. In the enhanced arm, participants could choose an electronic reminder device, three sessions of counseling either alone or with a treatment adherence partner, or both reminder and counseling. Survey assessments and blood draws occurred at baseline, post-intervention (13 weeks), and follow-up (25 weeks). Primary outcomes were 7-day and 30-day adherence assessed by self-report and electronic drug monitoring (EDM), and secondary outcomes were HIV-1 RNA viral load and CD4 count. The intervention was feasible and well received. It led to some improvement in self-reported and EDM-assessed adherence but not the biological outcomes. Providing counseling and facilitating the use of electronic reminders to patients initiating ART merits further investigation as a culturally viable means of promoting adherence in China.

%B AIDS Behav %V 15 %P 919-29 %8 2011 Jul %G eng %N 5 %R 10.1007/s10461-010-9828-3 %0 Journal Article %J AIDS Patient Care STDS %D 2011 %T "You must take the medications for you and for me": family caregivers promoting HIV medication adherence in China. %A Fredriksen-Goldsen, Karen I %A Shiu, Cheng-Shi %A Starks, Helene %A Chen, Wei-Ti %A Simoni, Jane %A Kim, Hyun-Jun %A Pearson, Cynthia %A Zhao, Hongxin %A Zhang, Fujie %K Adult %K Anti-HIV Agents %K Caregivers %K China %K Family %K Female %K Health Knowledge, Attitudes, Practice %K HIV Infections %K Humans %K Incidence %K Interviews as Topic %K Male %K Medication Adherence %K Middle Aged %K Motivation %X

China is experiencing a rapid increase in the incidence of HIV infections, which it is addressing proactively with broad implementation of antiretroviral therapy (ART). Within a cultural context extolling familial responsibility, family caregiving may be an important component to promote medication adherence for persons living with HIV in China. Based on 20 qualitative interviews with persons living with HIV and their family caregivers and a cross-sectional survey with 113 adults receiving HIV care at Beijing's Ditan outpatient clinic, this mixed-methods study examines family caregivers' role in promoting adherence to ART. Building upon a conceptual model of adherence, this article explores the role of family members in supporting four key components enhancing adherence (i.e., access, knowledge, motivation, and proximal cue to action). Patients with family caregiving support report superior ART adherence. Also, gender (being female) and less time since ART initiation are significantly related to superior adherence. Since Chinese cultural values emphasize family care, future work on adherence promotion in China will want to consider the systematic incorporation of family members.

%B AIDS Patient Care STDS %V 25 %P 735-41 %8 2011 Dec %G eng %N 12 %R 10.1089/apc.2010.0261