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

628 Abstracts ThPeF8177-ThPeF8180

XIV International AIDS Conference

transmission. A total of 720 visits were made by volunteers between April 1999
and December 2002 to 48 AIDS patients and 30 women and their babies.
Lessons learned: These weekly home visits by volunteers to AIDS patients and
seropositive new mothers and their babies were welcomed and appeared to produce a number of benefits. In particular, they helped improve the interactions
between patients and their caretakers, to reduce prejudice, and to break institutional barriers with improvement of the user/service relationship and an increase
in patients' self-esteem.
Recommendation: This "Therapeutic Friends" program has helped improve
medical care and quality of life of AIDS patients and their relatives. It appears
to be an effective method of encouraging education, health and citizenship in this
needy population.
Presenting author: Regina Tellini, Secretaria de Saude, Av. Presidente Kennedy,
2030, Praia Grande - Sho Paulo, CEP 11702-200, Brazil, Tel.: [phone],
Fax: [phone], E-mail: [email protected]
ThPeF8177 Stick with It - Adherence support for impoverished
urban populations in resource rich countries
D.C. Evans T. Reeves, M. Tye. Gay Men's Health Crisis (GMHC), New York,
United States
Issues: With the advent of effective combination anti-HIV treatments in 1996,
Gay Men's Health Crisis (GMHC) led the charge in New York to ensure access
to treatment for people living with HIV and to aid them in adhering to the complicated treatment regimens. As the numbers of poor clients with substance use
and mental health problems grew (up to 50% of clients), special programs were
built to aid these individuals.
Description: In the summer of 2001, GMHC launched the "Stick With It" program to aid impoverished communities of active users and mentally ill clients
in adhering to antiviral medication. The program employs intensive one-on-one
counseling and education, social support, and nutritional intervention to change
clients' thoughts and behaviors regarding their antiviral medication adherence. In
particular, the program addresses some of the most common reasons for nonadherence, including depression, social isolation, and crack and alcohol use.
Lessons learned: The amount of shame and denial that most clients possess
regarding their adherence problems makes them unlikely to self identify and seek
out programs. Further, in the New York urban area, thousands of impoverished
clients have limited access to adequate healthcare, nutrition and safe housing.
Thus, intensive case-finding and face-to-face outreach, including neighborhood
outreach and home visits, were needed to successfully recruit clients.
Recommendations: Peer support during the process can dramatically boost the
effectiveness of staff interventions. Most clients have a difficult time linking their
thoughts and behaviors with the negative consequences associated with nonadherence to antiviral medication. Frequent contact, and cognitive-behavioral interventions linked with education are key components of the program.
Presenting author: David Evans, GMHC, 119 West 24th Street, New York, NY
10011, United States, Tel.: [phone], Fax: [phone], E-mail: davide
@gmhc.org
ThPeF8178I The impact of affordable housing on treatment
adherence
S.W.H. Haikalis, A.C.C. Cunninghis. San Francisco AIDS Foundation, 995
Market Street, Suite 200, San Francisco, California, 94103, United States
Issues: Lack of affordable housing in San Francisco has made it very difficult for
people disabled by HIV/AIDS to be successful in HIV treatment adherence. Currently, there are 4,000 individuals on a waiting list for housing supported by AIDS
funding programs - CARE/HOPWA/Shelter Plus Care. Over 50% of the people
presenting for general crisis/support services at the SF AIDS Foundation do not
have permanent housing.
Description: This paper looks at two HIV+ client populations seen at the SFAF
and examines the impact of a rental subsidy on the client's ability to be independent, including improving their HIV treatment adherence. A majority of both
populations are triply diagnosed (HIV+/substance use/mental health diagnosis).
Case managers are assigned to all rental subsidy clients. Other clients are eligible for case management if they identify a life stressor that they are willing to
work on with a case manager. Both client populations are seen regularly and all
have access to a treatment support specialist, a financial benefits counselor, and
support groups at SFAF.
Lessons learned: Clients who are housed can focus on other life stressors. Substance use and mental health issues become more stable and clients have been
found to be adhering to HIV treatment. Side effects (i.e. diarrhea) are common in
both groups when on treatment, but clients housed are able to cope better with
finding solutions.
Recommendation: More advocacy with governmental entities (Federal/State/Local) is needed to increase funding for rental subsidies in large metropolitan areas

with high rental costs. Private support is not a practical solution due to the longterm nature of the need for permanent housing.
Presenting author: Susan Haikalis, 995 Market Street, Suite 200, San Francisco,
California, 94103, United States, Tel.: [phone], Fax: [phone],
E-mail: [email protected]

ThPeF8179 Adherence issues in paediatric anti-retroviral
therapy
S. Waugh1, S. Donaghy2. oPaediatric Psychology Service, St George's Hospital,
Paediatric Psychology Service, 5th floor Lanesborough Wing, St Georges
Hospital, London SW1i7 OQT United Kingdom; 2Children's Community Nurse,
Paediatric Infectious Diseases Department, St George's Hospital, London,
United Kingdom
Issues: Adherence to paediatric anti-retroviral therapy is notoriously problematic but essential in order to achieve viral suppression. Based on our previous
adherence survey which indicated low levels of adherence in some families, we
developed an enhanced questionnaire designed to identify the main barriers to
adherence.
Description: Information was gathered from carers of 33 of the 45 children on
ART who attend a South London family HIV Clinic. 91% of the children were of
Black African origin, with an average age of 8 years (range 1 to 15 years). 52%
were AIDS defining. A semi-structured questionnaire was used to elicit levels of
adherence, reasons for missing doses and views on possible ways to improve
adherence. 19 (age 6 - 15 years) children were also interviewed about their experience of taking medicine.
Lessons learned: 15% had missed doses of medication the day prior to interview and a further 21% reported non-adherence in the previous month. Reasons
carers gave for missing doses related to family organisational issues. However,
when questioned specifically about problems related to giving medication carers
perceived formulation difficulties as being the principle problem. 8 of 19 children
reported finding taking some of their medicines difficult and also gave reasons
related to palatability. The most frequently offered interventions to improve adherence included adjusting the regimen (5) and providing pill boxes (5).
Recommendations: It is invaluable to examine adherence levels and barriers in
depth, but assessment can be complex and time consuming. We have therefore
developed the Short Paediatric Adherence Questionnaire, for more regular use in
clinic. This will enable us to examine longitudinal aspects of adherence. Adherence continues to be a challenge and interventions should be tailored to specific
family needs.
Presenting author: Sarah Waugh, Paediatric Psychology Service, 5th floor
Lanesborough Wing, St Georges Hospital, London SW17 0QT, United Kingdom,
Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeF8180 Care Plus Program providing peer support in a
healthcare setting designed to increase adherance
in marginalized communities
J. Nahmias. Medical Management Adherence Coordinator, Waikiki Health
Center, Honolulu, HI, United States
Issue: Studies show treatment education and counseling enhance adherence to
HAART in marginalized populations and that on going support leads to continued
success. There are few innovative programs to address these needs.
Description: An increase in HIV+ clients and a lack of services led the Waikiki
Health Center, a primary care clinic serving marginalized populations, to develop
and deliver the "Care Plus Program". This two-year-old HIV specific program focuses on early intervention through mental health, adherence, nutrition, and substance use counseling. Unique to this program is an HIV + person trained to provide adherence support and education counseling in the job of adherence medical management coordinator, typically staffed by an MSW or RN with a scientific
background. The medical director, patient and coordinator develop an individualized treatment plan considering all aspects of each potential regimen and the
lifestyle and commitment of the patient. Initial weekly and subsequent monthly follow up calls are used to track progress and provide support. Medical status and
patient referrals are tracked. Weekly HIV team conferences offer time to discuss
patients with compliance issues and to share successes.
Lessons learned:
- Baseline assessments at diagnosis and prior to treatment, help patient and
healthcare team to plan treatment.
- Follow up by the coordinator ensures early intervention, fosters adherence
through peer support and discourages missed appointments. Patients may feel
less emotional guilt with a peer counselor and be more likely to accurately report
adherence.
- The patient should be involved in making decisions with their treatment.
Recommendations:
- HIV service providers should consider a peer-based approach to adherence
counseling.
- More research into the effects of peer based support and education on adherence.
- Emphasis on individualized treatment plans.
Presenting author: Jon Nahmias, Waikiki Health Center, 277 Ohua Avenue,
Honolulu, HI 96815, United States, Tel.: [phone], Fax: [phone],

E-mail: [email protected]