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

12th World AIDS Conference

Abstracts 32339-32343 589

32339 Are there gender differences in HIV adherence?
K.M. Nokes', I.B. Corless2, M.A. Brown3, J.G. Turner4, G.M. Powell-Cope5,
J. Inouye6, W.L. Holzemer7. 1CUNY, Hunter College/Bellevue Sch of Nursing
425 East 25th, Box 874, New York, NY 10010; 2MGH Institute of Health
Professions, Boston; 3 University of Washington, Seattle; 4 University of Alabama,
Birmingham; 5Haley Veterans' Hospital, Tampa; 6University of Hawaii at Manoa,
Honolulu; 7University of California, San Francisco, San Francisco, USA
Background: Adherence is recognized as a significant care issue in HIV management today yet gender differences have not been described. Researchers
at seven sites across the USA collaborated on a study examining adherence in
persons with HIV.
Methods: A descriptive, survey research design was used to assess HIV+/AIDS
patients demographic characteristics, disease severity, symptoms, engagement
with care, adherence, and quality of life. Data collection occurred at communitybased settings. The sample (n = 727) was 22.8% (n = 166) female. All instruments
were either validated scales with reported reliabilities or tested in this study. Adherence was measured using the Morisky Medication Adherence Scale (4 items,
alpha =.71), missed appointments in the last month (5 items), and follows health
care provider's advice (5 items). 72% of those with CD4 counts less than 500
reported taking daily HIV medications.
Results: Chi square and t-tests explored differences between men and women
and there were few demographic differences. The women were healthier (higher
CD4 counts, lower viral loads, and high physical functioning as measured by the
SF-36). Women reported a lower health perception (SF-36), greater depression
(CES-D), and more symptoms. They reported significantly less alcohol use and
more were either current or former drug users. There were no gender differences
on any of the three adherence measures. However, 58.9% (n = 428) of the total
sample reported forgetting their medications.
Conclusions: While there were no gender differences in adherence in this
sample, the majority of the subjects reported forgetting to take their HIV medications. Adherence intervention strategies designed for men and women will
be enhanced through greater understanding of the similarities and differences
between women and men living with HIV.
32340 Furthering compliance with triple antiretroviral therapies:
A common workshop between patients and a ward staff
Michele Gruffaz-Mauris'. Groupe De Compliance; Service Infectiologie; SMI
Centre Hospitalier 1 av. Tresums, 74011 Annecy Cedex; Reseau Ville Hospital
Aravih, Annecy 74000, France
Issue: 173 patients are treated by Triple Antiretroviral Therapy (TAT) in Annecy
Hospital. Difficulties in treatment compliance are reported both by patients and
the Infectious Diseases care workers team. Resolution of this hard problem is
placed as part of the activity of a "hospital-town Network" in which all the actors,
including patients, are participating.
Project: First, to understand reasons for difficulties in treatment compliance.
Second, to propose solutions in order to improve treatment adhesion and medical
follow up while preserving quality of life. A "driving group" was set up, constituted
by members of the Network (patients, health and social care workers) and of
the Ward, in equal number. Its aim is to initialize and support concrete actions,
to develop a common patients-health workers knowledge about TAT's effects on
everyday life.
Results:
1) Being with the patient as far as he takes a free and well thought-out decision
by:
- medical information about drugs: virus expected effects, possible adverse
events,
- nutritional consultation,
- nurse educational follow-up,
- easy access to the Ward psychiatrist or psychologist,
- attractive pill box and diary delivery,
- connecting with the Network "Talk group" and other support groups to meet
other treatment users.
2) Supporting the patient throughout his treatment by:
- Ward staff availability: permanent phone answer, wide medical disponibility,
quick side effects treatment, individual nurse and psychological follow-up,
- common physician and patient learning about unreported adverse events.
Lessons Learned: This experience started during Autumn 1997. Patients and
Ward care workers involved in this project are satisfied. They report benefits
from increasing communication and mutual understanding. The final aim is that
patients become less "compliant"and more "adherent".
32341 Safety, tolerance and adherence of late oral ZDV to
reduce perinatal HIV transmission, Bangkok
Nathan Shaffer', Rutt Chuanchoowong', S. Asavapiriyanont2,
P. Chaisilwattana3, N. Wanprapa3, V. Sangtaweesin4, W. Bhanichsupapol1.

'HIV/AID Collaboration PO Box 139, Nonthaburi 11000; 2Rajavithi Hospital,
Bangkok; 3Mahidol University, Bangkok; 4Children's Hospital, Bangkok; Thailand
Background: ACTG 076 demonstrated that a long treatment of mothers and
newborns with zidovudine (ZDV) can reduce perinatal HIV transmission. We are
conducting a randomized, double-blinded, placebo-controlled trial to evaluate if
a short, oral ZDV dosing schedule using a larger dose (300 mg) given less
frequently (twice daily) starting at 36 weeks gestation and every 3 hours during

labor is safe and effective in reducing perinatal transmission in settings where
the 076 regimen is not feasible. This analysis presents the safety, tolerance and
adherence data for this trial.
Methods: Safety is monitored by active surveillance for drug toxicity and
serious adverse events (SAEs), using ACTG guidelines. Maternal monitoring
includes weekly review of symptoms and examination and biweekly testing for
hematologic, hepatic, and renal toxicity through 1 month postpartum. Children
are monitored for hematologic indices and morbidity until 2 months of age. Study
drug adherence is assessed by weekly pill counts and self-report. Interviews were
done to determine possible barriers and facilitators of adherence.
Results: From May 1996 through December 1997, the full cohort of 397 HIVinfected pregnant women was randomized and started on study drug; 383 women
have delivered to date. Excluding 4 women (1%) lost before delivery, --99% of
weekly study visits were completed. Among the women, 35 SAEs have been
reported, most commonly for anemia (66%). Among the children, 30 SAEs have
been reported, most commonly for newborn hospitalization (77%). Thus far, there
is no tendency for SAEs to be associated with study drug. No woman has stopped
study drug because of side effects. Only 3 women (1%) took --90% of expected
antenatal doses. All women were able to tolerate the oral labor dosing.
Summary: A short ZDV regimen for HIV-infected pregnant women using a
larger antenatal dose less frequently than the 076 regimen and intermittent oral
dosing during labor appears to be safe and well tolerated. Study drug adherence
and follow-up are extremely high. If shown to be effective, this short-course
regimen would be feasible to implement in Thailand.
32342 Determinants of medication adherence in HIV+ women:
A pilot investigation
Ramani Durvasula, C. Golin, M. Stefanik. UCLA, 760 Westwood Plaza NPI
C9-533, Los Angeles, CA 90024, USA
Background: Accurate adherence to HIV antiretroviral therapy (ART) medication
regimens, particularly to "combination therapies" is of crucial importance, as drug
failure may occur in the face of decreased adherence (Vanhove et al, 1996). Given
that women are experiencing increasing rates of infection, this pilot investigation
was conducted to provide information about barriers to adherence among HIV+
women.
Methods: The present investigation is a cross-sectional pilot study examining
cognitive impairment and other determinants of adherence in a sample of HIV+
women. To date, data have been collected on 9 women (mean age = 36.3 yrs)
of varying ethnic background and SES from throughout Los Angeles county.
Women are administered neuropsychological testing and an interview exploring
adherence and knowledge about their medications and illness.
Results: Among the women interviewed to date 50% of the sample reports
that the demands of home or work ("being busy") was the main factor which
made adherence difficult for them, while 38% reported that fatigue related factors,
particularly falling asleep, was a factor impeding adherence. When participants
were asked about actual episodes of nonadherence, 33% reported that their most
recent lapse in adherence was attributable to falling asleep before taking their
medication, 22% reported that it was due to illness or hospitalization, and 22%
attributed it to wanting to avoid side effects caused by the medication. Other
reasons endorsed included being away from home, problems with children, and
being busy. All of the women in the sample were aware of the potential consequences of non-adherence, reporting either that they believe they would get
sicker (80%) or develop resistance (20%). Despite this, adherence in this sample
was equivocal, with only 33% of the sample reporting perfect adherence with
ARTs during the one week period prior to the interview
Conclusions: Preliminary results from this pilot study of adherence to ART
medications in HIV+ women reveal that a large percentage of women in this sample are not reporting accurate adherence to their medications, despite awareness
that adherence lapses may result in treatment failure. In this sample, physical
factors and lifestyle demands were found to underlie difficulties with adherence.
Documenting factors associated with adherence may assist in development of
adherence interventions responsive to the needs of HIV+ women.
32343 Improvement in sexual drive and a falling viral load are
associated with adherence to anti-retroviral therapy
Robert Pratt', N. Robinson1, H.P. Loveday', C.M. Pellowe', P.J. Franks',
C. Loveday2, R. Horne3. 135 Sherbrooke Road, Fulham, Thames Valley
University, London; 2Royal Free Hospital School of Medicine, London;
3 University of Brighton, Brighton, UK
Background: Non-adherence to anti-retroviral therapy is associated with an
increasing incidence of drug-resistant strains of HIV. This study examined associations between adherence to therapy and personal characteristics, clinical
variables, engagement with health care providers and quality of life.
Method: Interviewer administered instruments were employed to examine selfreports of adherence to anti-retroviral therapy in a cross sectional study of clients
from nine clinical centres in different geographical locations in England (30/centre;

n = 270). Using the Reported Adherence to Medication Scale (RAM) and the
Morisky Medication Adherence Scale (MMAS), adherence has been assessed to
date on the first 120 clients interviewed. Data were categorised and Chi squared
analyses performed.
Results: 78% were on anti-retroviral therapy, 66% were taking 3 or more antiretroviral drugs/day and 65% were taking more than 10 tablets/day. Of these, 53%
were under 40 years (range 18-74); 89% were men; 49% had CD4+ T-lymphocyte