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

12th World AIDS Conference

Abstracts 32358-32361 593

9 pts (45%) had wild type virus, suggesting non-compliance or sub-optimal
drug exposure. 6 pts have no virologic follow-up leaving 14 evaluable. Over
a mean follow-up of 4 months, 5/14 (36%) responded without a medication
change after subsequent MAE by the pharmacist specialist. Median baseline
HIV-RNA for responders was 76,700c/mL (19,300-236,000) and 131,000 c/mL
(17,900-499,000) for non-responders (p = NS). Genotype patterns were similar
for both groups. 2/9 non-responders and 5/5 responders received MAE.
Conclusion: Despite pt self-report of adherence, viral genotyping suggested
nonadherence in nearly half of pts failing HAART. For pts failing therapy due to
questionable compliance, viral response was less likely if no action was taken.
Interventions to improve adherence may prevent premature changes in HAART
in these pts. Comprehensive medication adherence enhancement intervention is
essential for all pts prior to changing HAART.
32358 Treatment adherence: Assessment of healthcare provider
assumptions and implications for clinical practice
Linda Frank, K. Waldron, J. Jerrett, C. Rowe, S. Fisk. Pennsylvania AETC
University of Pittsburgh Grad School of Public Health Pittsburgh PA, USA
Issues: Healthcare providers are currently faced with developing knowledge and
skills in enhancing patient treatment adherence to combination antiretroviral treatment in HIV disease. Providers may have assumptions about factors associated
with non-adherence that many impact the ability of some patients to gain access
to these new treatments. This study aimed to examine the assumptions and
knowledge in a cohort of health providers regarding perceived factors associated
with adherence to HIV treatment.
Project: Following a review of the literature on treatment adherence, a 15 item
survey instrument was developed to assess health provider perceptions of factors
associated with treatment adherence of patients being considered for combination
antiretroviral therapy. A sample of 107 healthcare providers completed the survey,
representing the disciplines of medicine, nursing, social work, & counseling.
Results: Analysis of the data indicates that overall, adherence is a major
concern of healthcare providers in treating HIV patients with the complicated
regimens. These data indicate providers understand both the need for more
patient education and the need for enhanced support services for persons with
HIV. Nurses were more confident than physicians in discussing adherence issues
and more likely to support use of combination therapy despite uncertainty of patient adherence. The most frequently reported factors associated with a negative
impact on patient adherence included: 1) lack of patient insurance; 2) increased
provider workload; and 3) fiscal and access problems associated with managed
care.
Lessons Learned: The results of this study indicate the continued need for
healthcare provider education on assessing patients for initiation and/or continuation of treatment, develop approaches and interventions to enhance adherence,
and methods to remove economic and systems barriers to HIV care.
32359 Compliance to multiple combination therapy with
antiprotease inhibitors among HIV-infected IDUs in
France (cohort MANIF 2000)
Maria Patrizia Carrieri, C. Reynaud-Maurupt, C. Pradier, J.P. Moatti. The MANIF
2000 Study Group; INSERM Research Unit, Istituto Superiore di Sanita
(ORS-PACA), Marseille, France
Objectives: To compare compliance to antiretroviral multiple combination with
or without antiprotease among HIV-infected IDUs and identify factors which are
potentially associated to low compliance.
Methods: Information was derived from the cohort study MANIF 2000 which
enrolled, from October 1995 to October 1996, 314 HIV- infected IDUs with CD4+
-300, clinical CDC stage A or B and attending south-eastern France and inner
suburbs of Paris hospitals. In the subsample of patients for whom antiretroviral
therapy was initiated in the last 6 months, a comparison of compliance was performed between those who received a bi-therapy without antiprotease (N = 36)
and those who had a triple combination with antiprotease (N = 30). Assessment of
compliance included detailed face-to-face interview about type of drug and number of pills taken during the last week before the interview and comparisons with
the prescribed medical regimen; psycho-social patients' characteristics, attitudes
and behaviours towards treatment were investigated using a self- administered
questionnaire.
Results: Full compliance was declared in the same proportion for both groups
(72% for bi-therapy vs. 73% for triple combination). Full compliance was not
associated with CD4 counts, viral load, clinical stage, socio-demographic variables and persistence of active drug use. Women seem to be less compliant
than men in both groups (52.6% in women vs. 74.5% in men) but this result did
not reach statistical significance. Active drug users were no more less compliant
than ex-IDUs, while among patients in triple combination, those who were in drug
maintenance treatment tended to be more compliant than those who were not
(85.7% vs 56.4%). Patients who had been hospitalised during the last 6 months
were more likely to be compliant to both types of treatment than the rest of the

sample (p = 0.003). Main reasons reported for justifying the lack of compliance
were: "being too busy" and "being asleep at the time of taking medication" or "just
forgetting".
Conclusions: Our data confirm that, at each period of time, about one third of
HIV+ patients have problems of compliance with antiretroviral therapy. However,
these problems do not seem to be exacerbated with multiple combination therapy
with antiprotease and among French active IDUs who have regular access to care.

Improving patients' compliance with antiretroviral therapy may necessitate more
frequent contacts with prescribing physicians and staff than current follow-up.
S32360 Multiple reasons for nonadherence to antiretroviral
medications in an inner-city minority population: Need
for a multifaceted approach to improve adherence
PaulJ. Weidle2, C.E. Ganea1, J. Ernst1, J. McGowan1, K.L. Irwin2,
S.D. Holberg2. 1Bronx Lebanon Hospital Center, Bronx, NY; 2Center for Disease
Control & Prevention, Atlanta, GA, USA
Background: Strategies to assess and improve adherence to medications should
be based on the validity of the assessment tool, as well as the factors associated
with nonadherence.
Objectives: To compare self-report of adherence in the preceding day with that
in the past month, examine the association between adherence and demographics
and behaviors, and describe reasons for nonadherence.
Methods: A cross-sectional analysis of persons on antiretroviral therapy in the
Bronx, New York, who were asked to quantify (anonymously) their adherence to
prescribed antiretroviral medications on the preceding day and one month before
the questionnaire. Reasons for nonadherence were solicited.
Results: During Sept - Dec 1997, 72 persons (40 men, 60 African-American or
Hispanic-American, 64 on public insurance) completed the survey. The percentages taking reverse transcriptase inhibitors (RTI), non-nucleoside RTI (NNRTI),
and protease inhibitors (PI) were 99%, 17%, and 57%, respectively. Nineteen
(28%) reported nonadherence to at least one medication on the preceding day
(RTI - 21%, NNRTI - 8%, PI - 23%); 25 (37%) reported nonadherence in the past
month (RTI - 32%, NNRTI - 9%, PI - 18%). Persons who reported non-adherence
on the prior day were 9.9 times more likely to report nonadherence in the prior
month than those who reported adherence (confidence interval [Cl] 2.9 - 33.2; p =
0.0003, Fisher's exact). Likewise, report of nonadherence to RTI was associated
with report of nonadherence to PI on the preceding day (odds ratio [OR] = 6.5; Cl
1.2 - 34.9; p = 0.04) and the past month (OR = 6.9; Cl 1.3 - 37.8; p = 0.04). On
initial analyses, age, sex, education, crack cocaine use, injection drug use, and
alcohol use in the past year were not clearly associated with nonadherence. A
total of 50 reasons for nonadherence were reported by 29 persons. The main reasons were toxicity (28% of reasons), lack of medications (26%), and forgetfulness
(24%).
Conclusion: A self-reported assessment of adherence on the preceding day
seems to serve as a good predictor for self-reported adherence in the preceding
month. Nonadherence to one drug class is associated with nonadherence to others. Neither drug nor alcohol abuse was associated with increased nonadherence
in these persons on therapy. Making medication regimens easier to remember,
ensuring a continued supply, and modifications to circumvent toxicities should
substantially improve adherence in this population.
32361 A qualitative study on retroviral therapy: Drug
compliance in IVDU patients
Ann-Marie Jones1, Hiten Thaker1, B. Foley1, C. Barry2, G. Prunty2,
B. Sweeney', G.J. Sheehan12. 1Mater Hospital Eccles Street Dublin 7;
2Beaumont Hospital Dublin 9, Ireland
Background: There is concern around the ability of intraveneous drug users
(IVDU's) to comply with anti-retroviral therapy (ART), IVDU's are least likely to be
offered ART. No qualitative study has been conducted among recipients of triple
combination ART. This study identifies social, personal and clinical factors which
influence compliance with ART in Irish IVDUs stabilized on methadone.
Methods: A qualitative semi-structured questionnaire was carried out on 23
patients, who were receiving ART. The data gathered included demographics
and an administered interview with six main open-ended questions. These included the persons IVDU history, attitudes to ART, coping mechanisms, social
and medical supports and psychological state. Interviews were recorded on tape
and the replies were then transcribed and colour coded according to the emerging
themes. Recurring themes were collated and analysed as to significance in the
overall study.
Results: Factors affecting commencement of therapy were: 1) attitude to HIV,
2) good support from partner and/or family, 3) state of health at the time of
commencement (i.e., either well but with low CD4 count and high viral load or
physically unwell with opportunistic infection), 4) positive reports about ART on
TV/newspapers, 5) conversations with doctors. Factors positively affecting continuance of therapy were: 1) positive attitude towards the future, 2) good relationship
with medical team, 3) a belief that ART improves survival, 4) a belief that ART
helps compliance with a heroin free state, 5) being in prison.
Conclusion: Our findings suggest that IVDUs are influenced by factors similar
to other populations both in their decision to commence ART and in their ongoing compliance. Other factors include that supervised administration and flexible
dispensing policy are available and that the drugs are free of charge. Our study
would suggest that individuals with a history of IVDU can become compliant with
ART once they are stabilized on methadone and fit the criterion as described

above before commencement.