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

12th World AIDS Conference

Abstracts 32366-32370 595

the complex interrelationships between the person and environment is found to
be significant in assessing and enhancing compliance with antiretroviral therapy.
Additionally, we believe that all PLWAs will be at risk for non-adherence at some
point in the course of their illness and that that adherence must be defined as a
continuum ranging from engagement in medical care to precision in medication
timing and dosage.
Lessons Learned: The eco-systems model can be effectively utilized as
the conceptual overhang, under which selective interventions can be analyzed.
Throughout the world, HIV affects individuals who are highly stigmatized, marginalized and often lack access to care. Therefore, one must be attentive at all times
to the fit between person and his or her environment. The purpose of the ecosystems perspective is to break through the limitations of the current model's
narrow focus and provide the practitioner with a more competent armamentarium
of "gold standard" interventions.
391 * / 32366 History of drug use and adherence in HIV+ persons
J.G. Turner1, K.M. Nokes2, I.B. Corless3, W.L. Holzemer4, J. Inouye5,
M.A. Brown6, G.M. Powell-Cope7. 1Univ of Alabama, School of Nursing, 1701
University Blvd., Birmingham, AL 35294-1210; 2CUNY, Hunter College, New
York; 3MGH Institute of Health Professions, Boston; 4 University of California,
San Francisco, San Francisco; 5University of Hawaii at Manoa, Honolulu;
6University of Washington, Seattle; 7Haley Veteran's Hospital, Tampa, USA
Background: Some have hypothesized that HIV clients with a history of drug
use may be more non-adherent than those without such a history. This study
examined the relationship between current/former injection drug use and never
used with three measures of adherence. Researchers at seven community-based
settings across the USA collaborated on this study.
Methods: A descriptive, survey research design was used to assess demographic characteristics of age, drug use, gender, race, and severity of illness with
perceived professional support and adherence. The sample (n = 727) was 22.8%
female, 56.8% non-white, with an average age of 39.4 years and CD4 count of
323. 56.8% reported never using injection drugs and 39.3% reported being former
or current user. Perceived professional support was measured by Engagement
with Health Care Provider (13 items, alpha =.96), Caring Scale (7items, alpha
=.92), and Satisfaction with Care (1 item). 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).
Results: Chi square and t-tests were calculated. Few differences in demographic variables were observed. The user group was somewhat older (mean
age 41.3 years vs. 38.0) and included more women (54% vs. 37%). Separate
step-wise regression analyses were calculated. Injection drug users were significantly more likely to report lower medication adherence scores, although the
amount of explained variance was modest (1.3%). Injection drug use was not
related to keeping appointments or following advice.
Conclusion: These findings suggest very modest differences in medication
adherence between current/former injection drug users and non users and no
differences in keeping appointments or following advice and instruction.
32367 Adherence to highly active antiretroviral treatments
(HAART): levels in the clinical practice and suggestions
to improve them
Albert Tuldra', M.F.L. Ferrer', C.R.A. Rodrigues', R.B.S. Bayes2,
B.C.S. Bellaterra2. 'Germans Trias I Pujol Hospital, Badalona; 2Autonomous
University of Barcelona, Bellaterra; 3Irsi Caixa Retrovirology Laboratory, Spain
Objective: To determine the index of adherence in HAART and study the efficacy
of an intervention to improve compliance.
Design: Longitudinal, controlled study.
Methods: 53 patients with HIV infection were interviewed after the physician's
visit. They were randomised in two groups: intervention/no intervention. The intervention group was counselled about how they should take the treatment and were
given a register to write the medication taken. The other group was only tested if
they had understood the therapeutic regimen. Both groups were asked for some
variables related to treatment. The adherence was mesured counting pills, levels
of drug in blood and compliance referred by the patient. After 20 weeks the index
of compliance was higher than the expected according to the experience with
retrotranscriptase inhibitors only. We asked 30 patients with HAART treatment out
of the study about their compliance the month before in order to have a reference
index.
Results: After 20 weeks we find no differences in adherence between the two
groups (p = 0.26). The level of adherence was 94.4%. In the group of patients
out of the study we found an index of adherence of 87%. We compared the
compliant patients in the study with the group out of the study. (The criteria was:
people compliant have more than 90% of adherence) and we found a significant
difference in a Chi-square test (p H.... 0.001).
Conclusion: Levels of compliance with HAART are higher than levels with
retrotranscriptase inhibitors only (about 50% in literature). The most important

difference between the studied group and the other patients is that all the people
in the study have an additional explanation about how take the treatment and they
know how to do it. This simple additional explanation may improve adherence.

S32368 Psychological well-being and HIV adherence
William L. Holzemer', J. Inouye2, M.A. Brown3, G.M. Powell4, I.B. Corless5.
J.B. Turner6, K.M. Nokes7. 1 Univ. of California, San Francisco, School of
Nursing, N505N, San Francisco, CA 94143-0608; 2University of Hawaii at
Manoa, Honolulu; 3University of Washington, Seattle; Haley Veteran's Hospital,
Tampa; 5MGH Institute of Health Professionals, Boston; 6University of Alabama,
Birmingham; 7CUNY, Hunter College, New York, USA
Background: This study examined the relationship between perceived psychological well-being and three measures of adherence: medication adherence;
adherence to advice and instruction; and adherence to apointments for visits,
procedures, and treatments. Researchers at seven community-based settings
across the USA collaborated on the study.
Methods: A descriptive, survey research design was used. Psycholgoical wellbeing was measured using several scales: depression (CES-D); subscales from
the SF-36 including Mental Health, Role/Emotional, and Vitality; Contentment
from the HIV Assessment Tool (HAT); Psychological Distress from the HIV-Signs
& Symptom Check List; and three scales from the quality of life measure, Living with HIV (Cherishing the Environment, Avoiding the Fear Zone, and Loss).
Adherence was measured using the Morisky Medication Adherence Scale (4
items), missed appointments in the last month (5 items), and follows health care
provider's advice (5 items). The sample (n = 727) was 22.8% female, 56.8%
non-white with an average age of 39.4 years and average CD4 count of 323.
Results: Step-wise multiple regression analyses were calculated. Three measures of psycholgoical support (Cherishing the Enviornment, Fear Zone, and
Role/Emotional) explained 9.6% of the variance in medication adherence. Two
variables exaplined 4.7% of the variance in missed appointments and three
variables explained 13.6% of follows advice and instruction.
Conclusion: Aspects of pscyhological well-being were related to each of the
adherence measures. The scale, Cherishing the Enviornment, was consistent
across all three solutions. Items on this scale include "feeling comfortable and
well cared for" and "having a meaningful life." Scale reliability was 0.72. These
findings suggest that people who feel well cared for are more likely to be adherent.
32369 1Increasing patient adherence: Experience with the "HIV
medication guide"
Rachel Therrien12, Anthony Gagnon3, Marjolaine Mailhot2. 11275 SW 46th AVE.
apt. 1308, Pompano Beach, Florida, USA; 2Centre Hospitalier de I'Universite de
Montrdal, Montreal QUE; 3JAG enterprises, Sudbury, ONT, Canada
Issues: Adherence to antiretroviral therapy has been identified as a key factor
for the success of aggressive regimens against HIV infection. Frustration over
the quantity of drugs to take in an unyielding schedule, apparition of untold side
effects and lack of understanding of the goals of therapy or the implication, often
result in poor adherence and treatment failure.
Project: Originally based on a successful guide to help patients design their
own drug administration schedule, the "HIV Medication Guide" now includes over
350 drugs involved in the management of HIV and opportunistic infections. Health
care professionals as well as patients can quickly design a medication administration schedule that reflects and can be integrated in someone's routine. Each
schedule is automatically checked for drug interactions against a very up-to-date
bank of over 650 interactions. The "HIV Medication Guide" also offers other
functions to improve adherence and help educating patients. These include: a)
nutritional and pharmaceutical tips that may help patients avoid or alleviate undesirable effects b) medication education pamphlets. Information about each patient
can be stored (PC version) and monitored over time. Health care professionals
can also keep track of the clinical progress (including CD4+ and viral load) of
individuals and monitor to impact adherence.
Results: The "HIV Medication Guide" has been made available in English
and French, in order to broaden its potential use; a Spanish version is being
developed. Through formal presentations to numerous community organizations
as well as through feedback from health care workers who used it, we validated
the software and modified it to better respond to the expressed needs. This
resulted in the release of Version 2.0. This project has been made available
free of charge to health professionals, and is also available on the internet at
http://www.jag.on.ca/hiv. Users from HIV clinics have been identified in Canada,
the United States, Brazil, and Germany.
Lessons Learned: Adherence to therapy is a very important issue in the
battle against HIV. The "HIV Medication Guide" designs individualized, optimal
drug administration schedules, detects drug interactions and offers appropriate
nutritional and pharmaceutical tips on how to avoid or alleviate some side effects
and improve compliance. We believe that knowledge and empowerment are the
first steps to better adherence.
| 32370 Low adherence in antiretroviral users at Sao Paulo, Brazil
Luis F.M. Brigido, A.P. Veiga2, A.C. d'Ambrosio2, A. Bueno2, J. Casseb2,
F.F. Galbitti2. 'Rua Dr. Arnaldo 355 Virologia IAL, Sao Paulo; 2Lab. Immuno.

Exp. Transplantion, Sao Paulo, SF, Brazil
Objective: To access the impact of compliance/adherence in therapy efficacy.
Design: retrospective, uncontrolled study
Methods: Clinical, immunological and virological data from 82 patients with information on adherence were obtained retrospectively from follow up information
at the Immunodeficiency Outpatient Clinic. CD4 counts were determined by flow
cytometry and Viral load by other Nasba or Amplicor kits.