GHDonline would like to welcome K. Rivet Amico as the newest moderator for the Adherence and Retention Community. Rivet is a research scientist at the University of Connecticut’s Center for Health, Innovation, and Prevention, and also works with Applied Health Research as a developer and trainer of interventions that use communication and counseling theory to support adherence and retention in the context of clinical trials and resource-limited settings.
Rivet volunteered to inaugurate our new “Member Spotlight” series in which GHDonline highlights work by members engaged in the communities. If you are interested in participating, email .
Rivet briefly answered these prepared questions and is pleased to answer your additional questions so please chime in!
1. What are your current research interests?
Presently, most of my efforts are centered on intervention and measurement in the areas of ARV adherence and product use in biomedical prevention clinical trials, as well as retention in HIV care once initiated. My interests are largely pragmatic- “what works best for who when” and how to measure it. My work also is grounded in theory and my counseling background. I increasingly find myself moving toward trying to develop, implement, and evaluate simple approaches to supporting difficult behaviors that also have the greatest chance of generalizing to real world settings. Implementation and dissemination science are underlying currents in much of my present research.
2. Can you describe a couple of projects you’re working on?
Presently, a few projects dominate my focus. I’m working with HPTN 067 (http://www.hptn.org/research_studies/hptn067.asp) on adherence to various PrEP regimens in men and women who have sex with men in South Africa and Thailand. My work with the iPrEx study (http://globaliprex.net/) focuses on the development and implementation of brief sexual health promotion discussions that incorporate risk reduction counseling with PrEP adherence support for their open label extension. I’m also involved in projects in the Deep South in the US on both ARV adherence and retention in HIV care, focused on developing effective intervention approaches to support both of these critical determinants of clinical outcomes. Across all of these projects I also work with measurement issues concerning adherence and strategies to improve self-report in the context of clinical trials.
3. You mentioned that you see tremendous opportunity and need for practice-based research and evidence. What does that mean and what would it look like?
To me, practice-based evidence is about looking to the practice community for guidance on what seems to be working well in clinical care, and conversely, what is not working so well. Practice-based evidence explores the effects of interventions and approaches developed “on the front line” as viable methods for establishing what is presently working well. We currently focus heavily on using research to guide practice for behavioral interventions, but often we hear how this can lead to clinics or organizations trying to implement research-evidenced interventions that feel like a poor fit to their populations or available resources. Less often do we hear about demonstrated grass-roots or real-world approaches to supporting adherence or retention in HIV-care applications. That may be partly because our collaborative efforts between research and practice are not leveraged as much as they could be.
There are methods and models for conducting practice-based research. One area that I think has immediate appeal is to use these strategies to identify the standard of care for ARV adherence, initiation of HIV-care, and subsequent retention in different regions. Despite many years of targeted efforts in these domains, we still don’t have a good sense of what characterizes standard practice in most places treating the bulk of people living with HIV. Recent work suggests that standard of care is variable and predictive of clinical outcomes when extracted from control arms in randomized control trials (see DeBruin and colleague’s work on this http://www.ncbi.nlm.nih.gov/pubmed/19916634). To me, that suggests many clinics have discovered and developed strategies to support adherence that would likely be demonstrably effective if measurement and evaluation were applied. I would very much like to see this area of research/practice collaborative efforts blossom over the next few years. Clearly, there is a lot to learn from each other and a critical role of networks like GHDonline is linking us together to have these conversations.
4. Are there any roadblocks or questions you’ve faced recently in your work that input from this community of 1,500 people from 106 countries could be useful?
More questions than I could reasonably list here! I was recently asked to give a talk about where this field (ARV adherence research) has been and where it may be going. This is something I feel increasingly unsure of (which may be a good thing) -- discoveries don’t often come from walking on well charted paths. So my broad questions relate to this:
Where do people see the field of studying and intervening in ARV adherence, treatment access, and retention in HIV-care going over the next few years?
What avenues of research are most relevant and useful within the GDHonline community?
If we set priorities or goals for the next 5 years for behavioral research in adherence to ARVs and care attendance recommendations, what might they be?