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

630 Abstracts ThPeF8186-ThPeF8189

XIV International AIDS Conference

clude baseline and follow-up interviews, HIV primary care visits, non-clinical adherence encounters, program descriptions derived from structured interviews with
providers, and provider assessments of program strengths and weaknesses. As
of October 2001, 1989 clients have been enrolled with 7,795 clinical visits and
19,222 non-clinical adherence-related visits.
Lessons: Data indicate high levels of adherence among clients attending adherence programs, with a mean baseline adherence of 85%, increasing to 90%
at first follow-up, and 89% at second follow-up (n=435). Quantitative and qualitative data indicate that factors operating at various levels impact on successful
implementation of adherence support. These factors include: the provision of adherence services concurrent with or prior to the initiation of HAART; flexibility
regarding the frequency of client contact; co-location of adherence services with
clinical care; communication among providers; multidisciplinary team approach,
including linkages with pharmacies; and use of various adherence tools, including
pillboxes and written instructions.
Recommendations: Adherence services should be client-centered, multifaceted
and delivered within the context of a multidisciplinary team approach. Clients tend
to disclose different levels of adherence to different members of the health care
team necessitating ongoing communication. Providing adherence support with
HIV primary care and linkages to community-based services helps to keep clients
motivated to remain active participants in their own care.
Presenting author: Mark Waters, AIDS institute, 5 penn plaza, New York, New
York, 10001, United States, Tel.: [phone], Fax: [phone], E-mail:
mdw01 @health.state.ny. us
ThPeF8186I The utilization of community resources to enhance
adherence to antiretroviral therapy in Harlem, New
York
A. Hofmann', E. Jervis', I. Cisse2, H. Dohnert3, A. Greeenwood4, S. Findley5,
S. Mannheimer6. 'Harlem Hospital/Columbia UniversityInfectious Diseases
Div, New York, NY, United States; 2Harlem Hospital, NY, United States; 3Harlem
Hospital, New York, United States; 4Harlem Hospital, New York, United States; 5
Harlem Hospital/Columbia University New York, United States; 6Harlem
Hospital/Columbia University, New York, United States
Issues: Persons living with HIV/AIDS (PLWHAs) in Harlem, New York face many
barriers to ART adherence: poverty, substance use, homelessness, mistrust of
health care providers, and weak social support networks.The community can be
a valuable resource for addressing clients' needs and delivering comprehensive
and culturally relevant services.
Description: The Harlem Adherence to Treatment Study (HATS), a peercentered adherence support program, integrates several community resources
to help PLWHA adhere to the ART HATS utilizes its own trained Peer Workers
(PWs) and HATS support groups to connect its HIV infected clients to their community and promote adherence to ART HATS PWs meet weekly with clients to
provide individualized support for ART adherence. Common cultural backgrounds
and experiences allow PWs to build empathetic and non-judgmental relationships
with clients. Relationships formed among clients participating in HATS support
groups can have similar effects. HATS clients are also referred to communitybased organizations (CBOs) based on individual needs identified through study
case management. HATS promotes links with local CBOs by hosting adherence fairs, collaborating in serving clients, and through participation in community
HIV networks. Collaboration with several CBOs optimizes client referrals to and
from HATS. Participation in community HIV networks strengthens collective and
community-centered strategies to fight HIV and promote ART adherence.
Lessons learned: Disadvantage communities harbor crucial resources for
PLWHA. In Harlem, PLWHAs, CBOs, and HIV community networks can be key
resources for building culturally relevant and cost-efficient programs to promote
ART adherence. Equitable, flexible and supportive relationships among the community's institutions create effective collaborations.
Recommendations: Integration of community services enhances service delivery and helps to provide culturally relevant programs for PLWHAs
Presenting author: Amparo Hofmann, Infectious Diseases Div., 506 Lenox Avenue, Room 3101A, New York, NY 10037, United States, Tel.: [phone],
Fax: [phone], E-mail: [email protected]
ThPeF8187 Support groups as a venue for promoting
adherence among inner city HIV-infected patients
J. Franks', S. Findley2, A. Rita 3, H. Dohnert', A. Greenwood4, E. Wilson1,
Y. Alonso', S. Mannheimer'. ClmbaUniversity Harlem Hospital Center, New
York, NY United States; 2Columbia University Mailman School of Public Health,
New York, United States; 3Harlem Hospital Center, New York, United States;
" hFloating Hospital, New York, United States
Background: Weak social support may represent a significant barrier to medication adherence (adh) for many HIV-infected patients (pts). Support groups (grps)

may help build support networks favorable to adh.
Methods: 138 pts in an antiretroviral adh support program were offered weekly
grps facilitated by program staff. We recorded topics discussed and levels of interaction in 100 grp sessions. We assessed pts' attendance at grps after 12 months
and obtained anonymous written feedback from pts every four months, with a total of 64 surveys completed. In addition, we conducted a focus group with 13 pts
to elicit more feedback on the grps.

Results: Among 103 pts in the program for 12 months, 62% (N=64) had attended
at least one grp, and these pts attended a mean of 7 grps, range 1-30. The most
common topics were education on HIV and adh (39%) and emotional issues,
such as despair over HIV infection and disclosing HIV status to new sex partners
(33%). Facilitators recorded that pts interacted steadily with each other in 83% of
grp sessions. In anonymous feedback, >99% of pts reported feeling that opportunity to speak in grp sessions was unimpeded. 46% (N=30) of respondants cited
social support as a primary motivation for initially coming to grps, followed by 25%
(N=16) whose attendance was motivated by interest in information about HIV and
adh. Equal percentages (32%) of the responses reported gaining in social support and in knowledge about HIV and adh through grps. Focus group participants
expressed such opinions as, "at first I didn't want to talk about... it [HIV] but now
when I come to support group, I'm around people like me, and I... relate to them,
and get a better understanding of what it is about."
Conclusions: Support groups offered in an adh support program had strong patient participation and high acceptability. The groups addressed potential barriers
to adh, including lack of HIV-related knowledge and social support.
Presenting author: Julie Franks, 506 Lenox Avenue, Rm 3101-A, New York, New
York, 10037, United States, Tel.: +[phone], Fax: +[phone], E-mail:
jf642 @ columbia.edu
ThPeF8188 The benefits of an adherence class in an outpatient
HIV clinic
L. Isaly1, C.A. Mayer', VS. Kenyon', J.L. Lennox-Smith2. 'St. Joseph's Hospital
Pinellas Care Clinic, 7720 balharbour drive, new port richey, florida, United
States; 2 Positive Education, Inc., "TA.S.K. author, Tampa, United States
Issues: Advances in the pharmacologic treatment of HIV/AIDS have afforded
HIV-infected individuals the opportunity for long-term viral suppression and
longer, healthier lives. The strict adherence to highly active antiretroviral therapy
(HAART) that is required is a complex undertaking for even the most motivated
patient. A Community Needs Assessment of Tampa Bay Florida HIV providers
and patients identified a perceived need for community-based adherence education for HIV-positive patients. It is presumed that an adherence class would result
in improved adherence to medical visits and medications therefore improving clinical outcomes.
Description: A 3-hour monthly Adherence Class, "The AIDS Survival Kit" (T. A.
S. K.), instructed by a nurse practitioner specializing in HIV care and a person
living with AIDS was initiated in January 2001. Topics included HIV virology, prevention/transmission, coping with medication side effects, and drug resistance.
Class attendees were pre- and post-tested to gauge knowledge retention.
Lessons Learned: Despite vigorous recruitment efforts and the use of incentives only 43(35%) patients attended classes. There was a 23% improvement in
knowledge level between pre- and post-test scores. The average time to post-test
score was 5.24 weeks (range 1 to 20 weeks). The mean baseline HIV viral load
was 3.64 log, and the mean post-class HIV viral load was 2.89 log. This paper
will also report the percentage of missed clinic visits in class attendees versus
non-attendees.
Recommendations: This research asserts that at least one third of patients will
make the effort to better educate themselves about HIV if given the opportunity.
Furthermore, it has been concluded by this research that basic HIV education
does increase patients' knowledge level. More evaluation is recommended to assess if increased knowledge about HIV translates into improved primary care
adherence and clinical outcomes.
Presenting author: leann isaly, 7720 balharbour drive, new port richey, florida,
United States, Tel.: [phone], Fax: [phone], E-mail: jlensmitty
@aol.com
ThPeF8189 Kitchen table wisdom: Improving medication
adherence through home visits and Freirian
education
A.B. Williams', C. Bova2, J.D. Burgess2, K. Danvers2, J. Malone2,
L. Saunders2, S. Winfield2, V. Odesina2. 1Yale University, New Haven, United
States; 2Yale School of Nursing, Yale School of Nursing, PO. Box 9740, New
Haven, CT United States
Issues: Medication adherence is a challenge for most people living with HIV.
Many adherence interventions are developed in clinical settings, while medications must be taken in the home or community.
Description: The ATHENA project (Adherence Through Home Education and
Nursing Assessment) uses a home visiting team (nurse and peer educator)
guided by the educational principles of Paulo Freire to encourage patients to explore how the social context limits or facilitates their ability to adhere to medication regimens. Through reflection/action/reflection, the team and patient interact
as critical thinkers to identify social and personal sources of adherence problems
and develop potential responses to those problems. Freire's educational strat
egy of codification allows the team to portray themes (e.g. stigma, lack of voice,
racism) uncovered in discussion. Codification techniques include role playing, stories, pictures, cartoons, poetry, and music. Discussion of themes are framed as
problem posing dialogue and patients are encouraged to take action to change
their situation when appropriate.
Lessons learned: Patients actively engage in critical thinking in the safe environment of the home, although establishing trust may require several months.