Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

586 Abstracts 32326-32330

12th World AIDS Conference

of 6.2 ~ 5.7 mo. Mean number of pills was 10.5 (4-17). AR adherence results
are below:
Timepoint Mean % Freq. of Freq. of Freq. of Freq. of 100%
(N) pill 80% pill 100% time 100% pill pill, time & diet
adherence adherence adherence adherence adherence
Baseline (49) 88% 86% 45% 35% 25%
1 mo. (36) 97% 97% 75% 92% 67%
3 mos. (18) 99% 100% 89% 94% 89%
(Note: p =.05, p <.05, p..005, p <.001 compared to data for same pts at baseline)
By multivariate analysis, high school education (p <.05) correlated with adherence, while former IDU (p <.05) and current substance use (p <.005) correlated
with nonadherence. All participants were enthusiastic about the ALR0M, however
some were concerned about its durability. ALR'" malfunctioning occurred for 50%
of pts.
Conclusion: Though the ALR" device has limitations, it was acceptable by
this population and significantly improved adherence with ARs, specifically with
number of pills and timing of doses.
392*/32326 Adherence to currently prescribed antiretroviral
therapies: Results from a multisite interview
project
Allyn K. Nakashima, Jeffrey L. Jones, D.A. Burgess, J.W. Ward. Centers for
Disease Control & Prevention, 1600 Clifton Rd., Mailstop E-47, atlanta, Georgia
30333, USA
Objective: To describe adherence to prescribed antiretroviral therapies among
HIV/AIDS patients.
Methods: We interviewed persons >18 years of age reported to health departments with HIV or AIDS in 6 population-based and 6 facility-based locations in 12
states in the US during 1997. Characteristics of persons who "always" adhered
to currently prescribed antiretroviral therapies were compared with those who
"usually" or "sometimes/rarely/never" adhered.
Results: Of 1,274 patients who completed an interview, 1,082 (85%) had ever
taken antiretroviral therapies, and 985 (77%) were currently taking them. Of those
currently taking therapy, 918 (93%) were taking 2 or more antiretroviral agents
and 849 (86%) were taking 3 or more medications. When asked how often they
took their antiretrovirals as prescribed 661 (67%) said "always," 228 (23%) said
"usually," and 90 (9%) said "sometimes, rarely, or never." The most frequent
reasons for not taking antiretrovirals as prescribed were "forget to take them"
(88), "can't work them into my schedule" (70), and "side effects" (60). Patients
were more likely to "always" take their medications as prescribed if they were not
injecting drug users (69% vs. 62%, p < 0.05), had not progressed to AIDS (84%
vs. 65%, p < 0.01), had received diagnosis <2 years earlier (76% vs. 60%, p <
0.01), or had been taking therapy for <2 years (73% vs. 56%, p < 0.01).
Conclusions: More than two thirds of HIV-infected patients indicated they "always" took their antiretroviral medications as prescribed. However, the ability to
"always" adhere to therapy lessened as duration of treatment increased. Dosing
schedules and formulations of medications that will assist patients in adhering to
complicated antiretroviral regimens over long periods are urgently needed.
S32327 Nationwide protease inhibitor adherence program
Julia C. Nissen, Lidia Gajewski, A.J. Grimone, G.J. Vanscoy. Stardtlanders
Managed Pharmacy Services, 5923 Bryant Court Pittsburgh PA 15206, USA
Issue: Patient adherence with protease inhibitor (PI) therapy is vital to the success of therapy, but difficult to achieve given the complexities of antiretroviral
therapy. In an effort to optimize therapy, it was critical to develop a systematic
method of assessing medication adherence in patients on PI therapy, identify
factors contributing to nonadherence, and evaluate the effectiveness of tailored
adherence interventions.
Project: Patients receiving PI therapy from the US's largest specialty HIV/AIDS
pharmacy are provided a customized Compliance Checklist each month as a
means to assess their medication adherence. Adherence data is obtained via
telephone interview if the checklist is not returned. Screening data is entered
into a customized electronic database that assigns one of three levels of adherence based on the patient's response. Each adherence level is associated with
specific intervention(s) and follow-up procedure(s). A multidisciplinary adherence
team provides education, counseling, social service assistance, and physician
consultation. Interventions are documented in a proprietary intervention database.
Results: The system tracks the number of screenings completed each month,
changes in self-reported adherence, viral load, and CD4 counts, and completed
interventions to evaluate the impact of the adherence program. Customized and
confidential reports will be available to select patients, healthcare providers, and
payors summarizing adherence trends and interventions.
The program continues to provide valuable insight into the factors that influence adherence to PI therapy and the interventions that are effective in improving

adherence.

32328 Adherence to quadruple therapy with abacavir (1592),
amprenavir, and Combivir'" in subjects with acute and
chronic HIV-1 infection
Priti Jhingran1, S.V. Pham1, J.M. Tolson1, M.H. Markowitz2, R. Kost2,
J. Johnson1. 117.1236 Five Moore Drive Glaxo Wellcome Inc. 2Aaron Diamond
AIDS Research Center New York NY USA
Background: Adherence to quadruple HIV therapy is critical and challenging. In
addition to the traditional clinical parameters, this open label, single center trial
evaluates adherence: barriers and motivators which may influence adherence
to quadruple therapy, twice daily regimen of abacavir (1592) (300 mg), 141W94
(amprenavir [USAN approved]) (1200 mg), and Combivir'" (AZT 300 mg/3TC 150
mg).
Methods: Protease inhibitor (PI) and Epivir-naive subjects (>18 years) are
being enrolled in this pilot study. Six month data is currently available for 13
acutely HIV-1 infected (<90 days post-infection) subjects and 11 chronically
HIV-1 infected (infected for >90 days) subjects. Plasma HIV RNA, safety, CD4
count assessments were obtained at baseline and at least monthly thereafter
during treatment. Patient medication adherence questionnaire(( V 1.0 1997 was
administered at 3 and 6 month clinic visits.
Results: Review of 3 month interim data for 13 subjects (8 chronically and
5 acutely infected) indicate that subjects reported missing their PI (amprenavir)
as often as they reported missing their reverse transcriptase inhibitors (RTIs)
(abacavir (1592), Combivir'"). A majority of the subjects reported missing either
none or only one or two doses RTIs (10 of 13 subjects) and PI (11 of 13 subjects)
over a 4 week recall period. Overall, subjects reported few barriers to adherence
with this regimen. However, 6 of 13 subjects reported that their medicines were
hard to swallow. No differences in trends were observed between the chronic and
acutely infected subjects. Results for 3 and 6 month visits will be presented.
Conclusion: Subjects self-reported adherence to a quadruple regimen of
abacavir, amprenavir, and Combivir'".
32329 Antretroviral use and adherence in a cohort of 696 HIV+
pregnant women
Barbara J. Turner', C.J. Newschaffer1, W.W. Hauck', D. Zhang1, L. Cosler2.
11 Thomas Jefferson University 1025 Wal Nut Street Philadelphia PA 19 107;
2New York State Department Of health New York NY USA
Objectives: To characterize use and adherence/continuity with antiretroviral therapy (ART) in a statewide cohort of HIV+ women and to identify maternal and
health care predictors of ART use and adherence.
Methods: We conducted a non-concurrent, prospective analysis of ART use in
HIV+ women who delivered a liveborn on New York State Medicaid from 5/94-9/95
and who were identified by a validated case-finding approach. Medicaid claims
files offered clinical, in-and outpatient medical care, and pharmacologic data.
Linked vital statistics files supplied additional clinical, demographic, and substance use data. ART was assessed in the 2nd or 3rd trimester. Any use was
defined as >1 claim(s) for an approved ART. Adherence/continuity was assessed
as the proportion of non-hospitalized days in the 2nd and 3rd trimester between
first ART use and delivery that were covered by days supplied on all claims for
ART (ie. good = >90%, limited = >50-90%, poor = <50%). From multivariate
logistic regression, predictors of any ART and adherence were identified.
Results: Of 696 HIV+ women, 323 (46%) had ART, rising from 32% in 5/94 to
65% in 9/95. In ART users, adherence was good for 32%; limited for 39%, or poor
for 28%. Adjusted odds ratios (AOR, 95% CI) for any ART use was higher for
Latinas vs whites (1.87, 1.01-3.50), USA vs foreign-born (2.39, 1.44-3.95), first
documentation of HIV+ status in 2nd or 3rd trimester vs earlier (2.50, 1.69-3.71),
prenatal care in 076 trial site (2.79, 1.81-4.31), and adequate prenatal care (2.31,
1.51-3.51). Lower AOR of any ART use was observed for: delivery in 1994 vs
1995 (0.39, 0.28-0.59), non-drug users vs drug users (0.44, 0.30-0.64), delivery
in New York City (NYC) vs rest of state (0.51, 0.31-0.84), and Medicaid eligibility throughout pregnancy vs partial (0.61, 0.41-0.91). Full adherence varied by
race (29% of blacks vs 45% of whites), delivery site (29% NYC vs 46% rest-of
state), prenatal care (29% adequate vs 46% inadequate). No significant adjusted
associations were observed for adherence.
Conclusion: ART use is rising rapidly but under-utilized by some racial-ethnic
groups, foreign-born women, and those with inadequate prenatal care. Adherence/continuity was inadequate for many women.
512*/32330 Saliva as a possible specimen for monitoring
compliance and plasma levels in patients treated
with indinavir (IDV)
Patricia W.H. Hugen1, D.M. Burger1, R.M.W. Hoetelmans2, K. Brinkman3,
P.L. Meenhorst4, J.W. Mulder4, P.P. Koopmans3. 1Dept. of Clinical Pharmacy,
Univ. Hosp., Nijmegen, PO. Box 9101, 6500 HB, Nijmegen; 2Dept. of Pharmacy,
Slotervaart Hospital, Amsterdam; 3Dept. of Internal Medicine, Univ. Hosp.,
Nijmegen; 4Dept. of Internal Medicine, Slotervaart H. S., Amsterdam,

Netherlands
Objective: To assess the use of salivary IDV concentrations to check compliance
and predict plasma IDV levels.
Methods: 14 HIV-infected outpatients, treated with IDV as a part of a triple combination therapy, were included. Plasma and citric-acid-stimulated saliva samples
were taken every hour from 0 to 8 hrs after a dose of 800 mg of IDV. The samples
were analysed for IDV by HPLC.