Objective: To pilot test the feasibility and impact of the iSTART program on medication adherence, quality of life, and medication barriers among adolescent/young adult (AYA) liver transplant recipients.

Methods: AYA liver transplant recipients (16-22y) were recruited to participate in a 3-month iSTART program, which involves tailored educational, motivational, and behavioral strategies delivered through text messages and web modules. The iSTART intervention incorporates motivational interviewing and cognitive-behavioral skills, including communication, organizational, and problem-solving skills. Participants completed baseline and post-intervention measures of quality of life (PedsQL), barriers to medication adherence (AMBS), and self-reported adherence. Adherence measures were obtained from medical charts. Results were analyzed with descriptive statistics and paired t-tests.

Results: 29 recipients enrolled in iSTART (M age: 19.3y). At baseline, 17/29 (59%) participants were classified as “adherent” based on a tacrolimus standard deviation (SD) <2. Of these 17, 2 did not complete iSTART. Of the 12/29 (41%) participants with baseline tacrolimus SD >2 (“nonadherent”), 5 withdrew before completing the iSTART program. Among the 22 completers, iSTART was met with high satisfaction and was associated with a significant reduction in the number of missed immunosuppressant doses per week (p=0.03) and a reduction of undetectable trough levels of immunosuppressant medication (p<0.01). At the end of the program, 11/22 AYA remained adherent, 5 improved their adherence, 3 decreased their adherence, and 3 had missing post-intervention data. iSTART completers had significant improvements in annual clinic attendance rates (p=0.02) and quality of life (p=0.04), and a significant reduction in the number of barriers to medication adherence (p=0.03).

Conclusions: Results of this pilot test suggest that iSTART is a promising self-management intervention for AYA transplant recipients. iSTART was met with high satisfaction and improvements in adherence, quality of life, and perceived barriers to medication adherence among the majority of participants. A substantial portion of nonadherent AYA did not complete the intervention. Of the 7 noncompleters, 71% were nonadherent at baseline. Thus, additional analyses are ongoing to determine factors predictive of attrition to improve retention of nonadherent AYA.

CITATION INFORMATION: Fredericks E, Eder S, Egleston D, Newhouse W, O'Reilly D, Freed G, Magee J, Resnicow K. A Pilot Test of the "Individualized Self-Management Training in Adolescent/Young Adult Recipients of Transplantation (iSTART)" Program. Am J Transplant. 2017;17 (suppl 3).

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