Patient activation and improved outcomes in HIV-infected patients

Rebecca Marshall, Mary Catherine Beach, Somnath Saha, Tomi Mori, Mark O. Loveless, Judith H. Hibbard, Jonathan A. Cohn, Victoria L. Sharp, P. Todd Korthuis

Research output: Contribution to journalArticlepeer-review

84 Scopus citations


Background: The Patient Activation Measure (PAM) assesses several important concepts in chronic care management, including self-efficacy for positive health behaviors. In HIV-infected populations, better self-efficacy for medication management is associated with improved adherence to antiretroviral medications (ARVs), which is critically important for controlling symptoms and slowing disease progression. Objective: To determine 1) characteristics associated with patient activation and 2) associations between patient activation and outcomes in HIV-infected patients. Design: Cross-sectional survey. Participants: 433 patients receiving care in four HIV clinics. Methods: An interviewer conducted face-to-face interviews with patients following their HIV clinic visit. Survey data were supplemented with medical record abstraction to obtain most recent CD4 counts, HIV viral load and antiretroviral medications. Main Measures: Patient activation was measured using the 13-item PAM (possible range 0-100). Outcomes included CD4 cell count200 cells/mL3, HIV-1 RNA400 copies/mL (viral suppression), and patientreported adherence. Key Results: Overall, patient activation was high (mean PAM=72.3 [SD 16.5, range 34.7-100]). Activation was lower among those without vs. with a high school degree (68.0 vs. 74.0, p.001), and greater depression (77.6 lowest, 70.2 middle, 68.1 highest tertile, p.001). There was no association between patient activation and age, race, gender, problematic alcohol use, illicit drug use, or social status. In multivariable models, every 5-point increase in PAM was associated with greater odds of CD4 count200 cells/mL3 (aOR 1.10 [95 % CI 1.01, 1.21]), adherence (aOR 1.18 [95 % CI 1.09, 1.29]) and viral suppression (aOR 1.08 [95 % CI 1.00, 1.17]). The association between PAM and viral suppression was mediated through adherence. Conculsions: Higher patient activation was associated with more favorable HIVoutcomes. Interventions to improve patient activation should be developed and tested for their ability to improve HIV outcomes.

Original languageEnglish
Pages (from-to)668-674
Number of pages7
JournalJournal of General Internal Medicine
Issue number5
StatePublished - May 2013
Externally publishedYes


  • HIV
  • Medication adherence
  • Patient activation
  • Patient outcomes
  • Self-efficacy


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