The Use of a Brief, Active Visualisation Intervention to Improve Adherence to Antiretroviral Therapy in Non-adherent Patients in South Africa

Non-adherence remains the largest cause of treatment failure to antiretroviral therapy (ART). Despite having the largest HIV pandemic, few successful adherence interventions have been conducted in South Africa. Active visualisation is a novel intervention approach that may help effectively communicate the need for consistent adherence to ART. The current study tested an active visualisation intervention in a sample of non-adherent patients. 111 patients failing on first- or second-line ART were recruited from two sites in the Western Cape, South Africa. Participants were randomly allocated to receive the intervention or standard care (including adherence counselling). The primary outcome was adherence as measured by plasma viral load (VL). There was a clinically significant difference (p = 0.06) in VL change scores between groups from baseline to follow-up, where the intervention had a greater decrease in log VL (M_adj = − 1.92, CI [− 2.41, − 1.43), as compared to the control group (M_adj = − 1.24, [− 1.76, − 0.73]). Participants in the intervention group were also significantly more likely to have a 0.5 log improvement in VL at follow-up (\(\chi_{(1)}^{2}\) = 4.82, p = 0.028, ɸ = 0.28). This study provides initial evidence for the utility of this novel, brief intervention as an adjunct to standard adherence counselling, for improving adherence to ART.