Research Activities, January 2014
HIV-infected patients with higher levels of patient activation are more likely to exhibit viral suppression
In the early years of the AIDS epidemic, the concept of patient activation for persons infected with HIV was involvement in demonstrations to push for more resources to cure or prevent the disease. Today, with effective treatments that keep the infection from progressing to AIDS, patient activation is still important—but on the personal level, according to a new study.
Specifically, the higher the patient's level of activation, as measured by a 13-item questionnaire (the Patient Activation Measure, or PAM), the higher their count of CD4 white blood cells (indicating a stronger immune system) and the lower the concentration of HIV RNA in their blood. The concept of patient activation in the study comes from the widely adopted Chronic Care Model, which has as one of its underpinnings that the degree of a patient's belief, knowledge, skill, and confidence to manage his or her own disease is critical to achieving optimal health outcomes.
The researchers found that the overall level of patient activation was high among 443 patients receiving care at four HIV clinics, with a mean PAM score of 72.3 (on a scale of 0–100). Patients without a high school diploma had significantly lower activation scores than high school graduates (68 vs. 74), as did the most depressed third of patients (68.1) compared with the middle third (70.2) and the least depressed (77.6). After adjustment for other possible risk factors, each 5-point increase in PAM score was associated with a 10 percent higher likelihood of a high CD4 count (above 200 cells/mL), an 18 percent greater likelihood of adherence to the drug regimen, and an 8 percent increase in viral suppression (less than 400 copies of HIV RNA/mL).
Further statistical tests indicated that the effect of PAM score was mediated by the greater adherence to medication. The study was funded in part by AHRQ (Contract No. 290-01-0012 and grant HS13903).
More details are in "Patient activation and improved outcomes in HIV-infected patients," by Rebecca Marshall, M.D., M.P.H., Mary Catherine Beach, M.D., M.P.H., Samnath Saha, M.D., M.P.H., and others in the May 2013 Journal of General Internal Medicine 28(5), pp. 668-674.