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

602 Abstracts 32400-32404

12th World AIDS Conference

HIV+ men and 22% for women. This study aims to describe how well HIV+
women are complying with combination therapy, and their reported reasons for
non-adherence.
Design: Cross-sectional interviewer-administered questionaire.
Methods: A consecutive sample of women coming for ambulatory care to
the main public clinic for HIV/AIDS patients (CRTAIDS) in Sto Paulo, a gold
standard care center, was invited to participate. Exclusion criteria included: age
under 18, being too ill to respond to questionnaire, accompanied by children at
time of visit, participated in a previous pilot study, or refusal to participate. 100
HIV+ women completed a private face-to-face interview which included questions
about demographic characteristics, sexuality and reproduction, needs assessment, knowledge about and compliance with guidelines for secondary prevention
& medication, & relationship with health care providers. During the interview we
provided available medications in their respective packages as a recall aid and
asked them to point out which they were taking, how much, how often, and why
in that way.
Results: 44% of the women were taking anti-retroviral medication, 22% of
them in a combination regimen. The compliance rate was: 41% for AZT, 45% for
Ddi, 21% for Ddc, 52% for D4t, 56% for 3Tc, 54% for Saquinavir, 31% for indinavir
and 44% for Ritonavir. They skip doses, and don't always take medication as
directed. The main reason reported for non-adherence was "forgot"(35%), context
& situational obstacles (15%), side effects (9%) and lack of understanding about
instructions. Compliance with AZT only, women were more likely to adhere if they
are employed, have a higher level of education and are comfortable talking about
regimen decisions and sexuality with their doctor.
Conclusions: Non-compliance can endanger both individual and public health.
These data suggest that we should combine universal access with more structured, gender-sensitive support (secondary prevention education programs, and
educational programs, and educational materials developed in collaboration with
HIV+ women) and insist that the pharmaceutical industry create packaging, and
regimens which facilitate compliance.
32400 Obstacles in treatment adherence: Patient reasons
Mario Burgos, N.S. Revsin, A. Vilas, L. Fontan. Fundacion RED-Resources
Studies Development, Cucha Cucha 1153, Ciudad De Buenos Aires, Argentina
Issues: (1) There are emotional, social and financial reasons, regardless of undesirable side-effects due to which patients see themselves as being forced to
change their medicine intake timetables and/or sequencing, and/or interrupting
drug therapy. (2) The latter hinder treatment adherence, thus the physician's
not taking these issues into account during the patient appointment eventually
impinges upon adherence.
Method: Written record keeping of all phone calls to Fundacion R.E.D.'s hotline,
queries to counselling/psychological therapy patients and their phycisian, interviews with health team professionals and pharmaceutical companies, adherence
"solution-finding" workshops.
Results: Out of 179 patients surveyed only 43.02% kept the medication intake
regime as prescribed, 30.16% admitted having interrupted their regime for at least
one day, 37.43% admitted not knowing partly intake instructions. Main reasons
quoted as adherence drawbacks: problems in getting medication re-supplied
24.09%, avoiding side effects in key situations (i.e., starting a new relationship,
job interview) 19.60%, work-place related intake problems 16.66%, learning of
other patients' treatment failures 8.8%, news of worsening or death of affected
persons 8.8%, unprescribed drug intake or alternative therapies 5.8%. In the
special case of HIV positive mother and child patients: mothers (13.72%) claimed
the main personal adherence problem to be upkeeping their children's treatment.
Conclusion: For effectiveness's sake the concept of adherence must include
taking into account the patient's living circumstances and his/her environment
when prescribing any particular treatment modality.
S32401 Adherence to ACTG 076 regimen in a developing country
- Porto Alegre, Brazil
Regis Kreitchmann. Rua Dos Andrados, Porto Alegre; STD/AIDS Municipal
Program, Brazil
Objectives: Identify barriers to adherence to zidovudine prophylaxis in vertical
transmission of HIV
Design: Transversal study
Methods: From August 1996 to January 1998 we followed 64 HIV pregnant
women in a Clinical Center of STD/AIDS treatment. We evaluated epidemiological
data from a uniform inquiry focused in treatment adherence.
Results: Maternal characteristics at entry were: mean age: 24 years (range
between 15 and 43); infection by heterosexual contact: 87.7%; mean CD4: 611
cell/mm3; concomitant serologic tests positive for Syphilis: 15.2%; mean gestation
age at initiation of AZT: 23 weeks (53.3% between 14 and 24, 33.4% between 25
and 35 and 3.3% > 36 weeks). 7 women had a prior infected children. Among
present partners 43.4% were tested HIV positive, 18.9% were HIV negative and
the serologic status of the others was ignored. Three patients discontinued prenatal care although they consent to use the AZT and 20% used AZT in irregular

basis. 17 patients received other antiretroviral drug besides AZT. The mean number of prenatal visits was 3. Intrapartum AZT was not received by 4 patients, 2 of
whom arrived at the maternity hospital in late stages of labor. All newborns were
provided by formula; 5 didn't received postnatal AZT. Identified reason to have not
received AZT syrup was: no availability of the drug or the doctor didn't prescribe.
Cesarean section was performed in 29.2% of the patients. 12 patients missed at

least one part of the AZT regimen. Non adherence was strongly related to having
a prior infected children or a actual infected partner (OR 2.0). Adherence was
better with the use of other antiretroviral drugs besides AZT (OR 4.67)
Conclusion: Patients frequently didn't adhere in AZT prophylaxis to prevent
vertical transmission. Barriers to adherence must be recognized and serve as the
basis for intervention strategies in such a way to improve HIV vertical transmission
rates.
132402 Prevention of losses to follow up during clinical trials
Jose Luis Valdespino Gomezl1, Leticia Dolores Ferreyra Reyes22, V. Campos
Hernandez33, J. Martinez Badillo33, M.E. Jimenez Corona22, M.E. Mayar
Maya22, M.L. Garcia Garcia22, M. Palacios Martinez22. 1Ave Universidad 655,
Cuernavaca Morelos C.R 62508; 2 nstituto Nacional De Salud Publica,
Cuernavaca MO; 3Fundacion Mexicana Lucha Contra El Sida Mexico DF, Mexico
Background. Clinical trials are the most effective means of obtaining information
about efficacy, adverse effects and compliance of therapeutic measures. Their
cost limits their extended use. Optimization of strategies for conduction of these
trials is pertinent.
Objective: To identify characteristics of patients associated to losses to follow
up during clinical trials.
Methods: A multicentric prospective, clinical trial for chemoprophylaxis of tuberculosis was conducted in Mexico City from Dec, 1993 to October 1997 on
non pregnant adult, HIV-1 positive, Karnofsky scale above 60%, PPD positive
subjects. Profile of patients who were lost to follow up were compared with rest
of patients
Results: 181 patients were recruited and followed for an average of 40.4
months. 21 patients (11.6%) were lost to follow up. Patients lost to follow were
most probably from socially disadvantaged groups (homeless, prisoners). However, no difference was found regarding sociodemographic characteristics.
Conclusions: Loss to follow up has multiple causes. We were unable to identify
sociodemographic characteristics in patients who were lost to follow up. Socially
disadvantaged groups require specific strategies to improve compliance.
Partially funded from National Institutes of Health (USA)/Panamerican Health
Organization
32403 Factors associated in a Hispanic cohort with effective
adherence and desired clinical results in patients with
triple antiretroviral therapy (including one PI)
Marisol Martinez1, Antonio Marques1, Jennifer Valdes2, Jorge Santana2. 1Ave
Fernandez Juncos stop 19 #1306, Santurce, Puerto Rico; 2San Juan AIDS
Program, Santurce, PR, USA
Objectives: To study and identify factors that can assist a physician to select
adequately patients to be started on protease inhibitors.
Design: Retrospective, controlled study.
Methods: Adult; HIV confirmed patients were evaluated when non detectable
viral loads were achieved and were sustained for more than 10 months. Both
groups were evaluated for:their past medical hx; social hx; drug allergies, physical;
routine labs; immunological values; viral load prior to starting them in protease inhibitors. Sociodemographic factors such as age; scholarity, income, living status,
marital status, risk factors and others were evaluated as well. Baseline and continuous psychological, social and medical status were evaluated every 2 months
to assess any changes.
Results: Eighty percent of the patients who achieved desired results were
found to have higher incomes, and more than 80% were found to have higher,
educational levels; more stable mental health, more long term plans and goals.
54% acquired HIV through homosexual contact and 42% through heterosexual
contact and 40% through intravenous drugs use.
Conclusions: Elegibility criterias are being studied in many areas where the
impact of this disease is significant (San Juan has a seroprevalence of 2%) and
in places where accesibility is limited. Etics is a concern in our providers. Our
study will help use factors that can predict better clinical response and a more
effective use of these medications.
|32404 Factors which influence adherence to the use of protease
inhibitors
Jucara Arabe1, N.P.M. Rubini, A.C.A. Rodrigues, D.W.C. Leal, E.H.S. Freitas,
F.S. Sion, C.A. Morais-de-sa. University of Rio de Janeiro; 1Rua Antonio Basilio,
123/Apto. 102, Tijuca, Rio de Janeiro, RJ, Brazil
Objectives: To investigate adherence rate to the use of protease inhibitors in
adults, and the factors related to non-adherence.
Methods: A retrospective study of 47 adults selected among in patients from
the Immunology ambulatory, older than 18 years, or both genders, and who were
using protease inhibitors (PI) for a period of 6 months or longer. All the patients
received PI from the Ministry of Health for free. We considered total adherence
when the patient referred to take every single dose, partial adherence when the

patient didn't take the drug(s) for a period shorter than one week, and interruption
when the period without taking the drug(s) was longer than one week. Statistical
analysis was made by Fisher's test.
Results: Among 47 patients evaluated, 29 (62%) were male, 31 (65.9%) white,
and the median of age 35, (range 24 to 64). Patients had been using PI for periods
varyng from 6 to 16 months (median = 7, mean = 8.54 ~ 2.64). Six patients used