Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

46 Abstracts WePeB5860-WePeB5863

XIV International AIDS Conference

do not adhere to treatment to some degree. Many physicians assess the failure
to follow instructions as ignorance and lack of cooperation of patients. However,
physicians are notoriously poor in predicting adherence. Understanding Latino
cultural perspectives that impact adherence could improve patients ability to follow complex HIV regimens.
Methods: This is an exploratory descriptive study based on five focus groups
and five key informant interviews. Responses were categorized into: cultural dimensions pertaining to clinician's attitudes; institutional policies, and strategies
developed by patients and providers to improve adherence.
Results: Patients in focus groups reported strong family ties that may serve as
support for persons living with HIV; at times these same strong ties can make
it difficult to adhere to HIV medication when stigma about HIV is strong. Patients were reticent to initiate conversations with physicians about adherence.
Case managers played a key role in interpreting physician instructions and assessing adherence. Key informants reported a lack of institutional culture to support physicians in understanding barriers to adherence and communicating effectively to improve adherence. They also recommended training persons with HIV
as counselors to be employed at HIV clinics.
Conclusions: Adherence to treatment must be seen within the framework of empowerment in the process of decision-making in the patient-physician relationship. Clinician education that includes strategies to empower patients in communicating with their physicians could positively impact adherence. Education for
clinicians should not only include updates in medical treatment but also strategies
to empower patients.
Presenting author: Angel Braha, 3020 14th NW, Suite 403-G, Washington DC,
20009, United States, Tel.: [phone], Fax: [phone], E-mail: angelbranamd @ aol.com
WePeB58601 Causes of ARV Failure In India
D.G. Saple1, S.B. Vaidya2, R.D. Kharkar3, V.P. Pandey4, R. Vedrevu5,
J.P. Ramnanai6, S. Arsad7. 1Grant Medical College & G T Hospital, Mumbai,
601/602,Suraj Venture, B Wing, Bhagoji Keer Marg, Mahim, Mumbai 400 016,
India; 2 K J Somaiya Medical College, Mumbai, India; 3Holy Family Hospital,
Mumbai, India; 4 M G M Medical College & M Y Hospital,Indore, India; 5HIV
Referral Center, Kakinada, India; 6U/hasnagar HIV Clinic, Ulhasnagar, India;
7HIV Referral Center, Amravati, India
Background: With availability of more ARV agents in India at reduced prices,
their use has perceptibly increased. While this represents a great opportunity for
our patients, unless used judiciously, the failures & evolution of drug resistance
strains represents a grave danger to the world.
Methods: 200 patients referred to our Centers, previously started on ARV for
varying periods & not responding well, were analyzed for causes of treatment
failure on following parameters-Patient's Factors: Financial & educational background; Compliance & adherence; Therapy interruption. Doctor's Factors: Prior
counseling for ARV; Determination of therapy goal; Drug doses & combinations;
Management of O.s. Drug Factors: Availability & accessibility; Cost
Results: 30%, 39% & 31% of the patients were from the low, middle & high
income groups respectively. 32% were literate. Only 10% patients were counseled prior to initiating ARV. Adherence was seen only in 10% of the cases and
all were on PI-sparing regimens. Therapy interrupted by > 50% patients lured
by outrageous claims of "miraculous cure" by traditional healers. Long-term goal
of therapy not determined in > 90% cases. Dual drugs regimen used in 70%
cases. Monotherapy seen in 23%. Incorrect doses amongst 80% of these cases.
Improper combinations with incorrect doses were seen in another 4% cases. In
61% ARV therapy was used without treating underlying O.Is. Urban patients had
access to drug where as 49% from rural had difficulties. Cost of ARV therapy is
a major limitation & even in the high-income groups the PI based regimens are
beyond reach in long-term.
Conclusions: Initiation of salvage regimens from amongst the meager number
of currently available drugs showed improvement in 30% of these previously failing cases. Aggressive steps to train clinicians in India need to be taken urgently.
There is need for new molecules & to study drug resistance in India. Only specially trained doctors should prescribe these drugs.
Presenting author: Dattatray Saple, 601/602,Suraj Venture,B Wing,Bhagoji Keer
Marg,Mahim,Mumbai 400 016, India, Tel.: [phone], Fax: [phone]
0754, E-mail: [email protected]
WePeB5861 Application of a multidisplicinary programme of
adherence to antiretroviral treatment. Preliminary
results
M. Benaus, L. Fernandez, G. Navarro, A. Torres, P. Bescos, M. Perez, M. Sala,
M. Cervantes, F Segura. Corporacion Parc Taul, Corporacih Parc Tau/l,
Residencia Albada, Parc Tauli s/n, 08208 Sabadell / Barcelona, Spain
Background: The highly effective antiretroviral treatment has changed the prog
nosis of HIV-infected patients, but it requires a continued scrupulous compliance,
which is influenced by diverse factors. The objective of the study is to elaborate
and apply a protocol helping patients to achieve the optimal compliance with antiretroviral treatment.
Method: In a 714 bed General Hospital, covering an region with 388,341 inhabitants. At the beginning of 2000, a prevalence study was conducted, based on
a protocol to determine the patients' initial percentage of therapeutic adherence,

which provided information on the importance of emotional aspects. The health
care programme was applied to patients starting the treatment, and to those presenting important adherence difficulties. Participation in the study was voluntary
Socio-demographic, behavioural, psychological, social and adherence variables
were analysed. The programme consists of a diagnostic visit and 5 follow-up visits.
Results: The multidisciplinary process of elaborating the programme permitted
to include in it multiple adherence factors. The prevalence study applied to 80
patients showed a correct degree of adherence in 60% of the patients, stressing
the important of emotional factors as factors that hinder adherence. At the end of
2001, 20 patients were included in the programme, 10 of which gave up at different stages due to different reasons. Of the 10 patients that continued with the
study, 6 exceeded 6 months of follow-up, with an optimal treatment compliance of
100%.
Conclusions: The multidisciplinary approach and the previous diagnosis of factors involved in adherence permit to elaborate an effective adherence programme
of the antiretroviral treatment for a numerous group of HIV-infected patients.
Presenting author: Montserrat Bernaus Marti, Corporaci6 Parc Taulf, Residencia Albada, Parc Taulf s/n, 08208 Sabadell / Barcelona, Spain, Tel.: [phone]
10 10, Fax: [phone], E-mail: [email protected]
WePeB5862] Predicting acceptance of highly active
antiretroviral treatment (HAART): the role of
patients' perceptions of illness and treatment
R. Horne', V. Cooper', G. Gellaitry', N. Lambert', M. Fisher2. 1University of
Brighton, Centre for Health Care Research, Brighton, United Kingdom; 2Royal
Sussex County Hospital, Brighton, United Kingdom
Background: This study aimed to improve our understanding of why approximately a third of patients decline HAART when it is clinically indicated. We hypothesised that the decision to accept or decline HAART would be predicted by
patients' personal beliefs about HAART and HIV as specified in an extended selfregulatory theory.
Methods: A prospective, longitudinal study in which consecutive patients offered
HAART (within BHIVA Guidelines) completed validated questionnaires assessing perceptions of HIV (symptoms, timeline, personal consequences, amenability
to control and emotional impact) and beliefs about HAART (perceptions of personal need for HAART and concerns about potential adverse effects). The effect
of baseline beliefs on the subsequent decision to accept or decline HAART was
examined.
Results: Sixty-two (73%) patients accepted HAART and twenty-three (27%)
declined. There was considerable variation in personal beliefs about HIV and
HAART These beliefs influenced uptake. Choosing to decline HAART was associated with doubts about personal need for HAART (t=-3.30; P<0.001) and to
a range of concerns about potential adverse effects (t=2.72; p<0.005). People
who accepted HAART had a greater belief in the ability of HAART to control their
condition (treatment control t=4.25, P<0.0001) and were more likely to believe
that their condition would improve in time (timeline t = -3.37; p < 0.005).
Conclusions: Patients' beliefs about HAART and HIV often differed from the
'medical view' yet strongly influenced the decision about whether to accept or
decline HAART, when clinically indicated. The findings of this study will be used
as the basis for an intervention study to assess the effects of 'decision support'
on uptake of HAART. We are extending the study to assess the effects of these
beliefs on subsequent adherence.
Presenting author: Rob Horne, Centre for Health Care Research, University
of Brighton, 1 Great Wilkins, Falmer, Brighton BN3 5PE, United Kingdom, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
WePeB5863 Predicting non-adherence to HAART: the role of
patients' doubts about personal need and
concerns about potential adverse effects
R. Home', V. Cooper', M. Fisher2. 'University of Brighton, Centre for Health
Care Research, Brighton, United Kingdom; 2Royal Sussex County Hospital,
Brighton, United Kingdom
Background: We present the preliminary findings of a study to test whether patients' perceptions of HAART prior to starting treatment predict subsequent adherence. It is the first longitudinal study to identify predictors of adherence that
are amenable to intervention. We hypothesised that adherence to HAART at 1
and 3 months would be predicted by baseline beliefs about personal need for
HAART and by concerns about potential adverse effects.
Methods: A prospective, longitudinal follow-up study in which consecutive patients (n=46; response rate = 81.5%) accepting an offer of HAART (made according to BHIVA Guidelines) completed a validated questionnaire assessing perceptions of personal need for HAART and concerns about potential adverse effects.
A necessity-concerns difference (NCD) score was calculated for each individual

as a numerical indictor of perceived need relative to concerns. Participants were
separated into high and low adherence groups (reporting taking < 90% HAART
over the previous month or stopping HAART without consulting a doctor). The
effect of baseline beliefs on subsequent adherence was assessed.
Results: Patients' perceptions of HAART before starting treatment predicted subsequent adherence. Low adherence at tl=1month and t2= 3 months was predicted by baseline concerns (tl=2.1; p<0.05 and t2 =3.07; p<0.005) and by the