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Front Pharmacol. 2019 Aug 21;10:901. doi: 10.3389/fphar.2019.00901. eCollection 2019.

Problem-Based Learning Could Tackle the Issue of Insufficient Education and Adherence in People Living With HIV/AIDS.

Zhang Y1,2,3,4, Xu G3, Hou J1, Shi P3, Chang S5, Wu A6, Song A1,4, Gao M1, Cheng X7, Cui D7, Wu H1,4, Huang X1, Shi J2,8.

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Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China.
National Institute on Drug Dependence, Peking University, Beijing, China.
Dermatological department, Qingdao Infectious Diseases Hospital, Qingdao, China.
Beijing Key Laboratory of AIDS Research, Beijing, China.
Institute of Mental Health/Peking University Sixth Hospital and Key Laboratory of Mental Health, Peking University, Beijing, China.
The Aaron Diamond AIDS Research Center, The Rockfeller University, New York, NY, United States.
Education Department, Beijing You'an Hospital, Capital Medical University, Beijing, China.
Beijing Key Laboratory on Drug Dependence Research, Beijing, China.


Background: Poor medication adherence is still the main cause of antiretroviral therapy (ART) failure among people living with HIV/AIDS (PLWHA). Effective behavioral interventions are needed to improve HIV awareness and medication adherence. Methods: In this retrospective cohort study, we assessed the effect of problem-based learning (PBL) approaches to HIV-related education and adherence outcomes among PLWHA and a college student sample. In our study, compared with 309 demography-matched control participants using conventional counseling methods (109 PLWHA and 200 college students), 321 subjects (111 PLWHA and 210 college students) chose to learn HIV-related knowledge via PBL-integrated methods. Co-primary outcomes were self-administered questionnaire after HIV-related education by all participants and self-reported medication adherence by newly diagnosed PLWHA, measured in terms of the number of missed doses in the past week at each of the seven visits during a 1-year period. Multivariate regression models adjusting different covariates were used to test the robustness of HIV awareness and adherence association. Mediation model was used to investigate the relationship among PBL training, awareness of HIV, and ART adherence. Results: The knowledge scores of participants in the PBL group were higher than those in the controls (P = 0.001), especially the subgroup of newly diagnosed PLWHA in the PBL group (P = 0.001). The HIV-related health scores of the PBL college students were also higher than those of subjects exposed to conventional education (P < 0.001). There was no significant difference between the two by newly diagnosed PLWHA groups in the number of missed doses during the past week at each visit except at the first follow-up visit (P = 0.018). The indirect effect of PBL-integrated education on ART adherence at the 2-week visit through HIV awareness had a point estimate of 0.0349 and a 95% bias-corrected bootstrap confidence interval of 0.0061∼0.0874 in newly diagnosed PLWHA. Conclusions: PLWHA and college students using PBL showed improved awareness of HIV and higher levels of recent ART adherence; however, there was no change in long-term ART adherence in newly diagnosed PLWHA.


adherence; awareness; education; people living with HIV/AIDS; problem-based learning (PBL)

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