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

632 Abstracts ThPeF8194-ThPeF8198

XIV International AIDS Conference

ThPeF81 94 Alternative methodology to overcome hiv/aids
issues in medium complexity hospitals
R.N. Escobar1, S. Arminchiardi2, E. Rolon2. 1Hospital Intendente Carrasco,
conscripto bernardi 6363 a, 2000 - rosario, pcia. de santa fe, Argentina; 2Hosp.
Roque Saenz Pefia, Rosario, Argentina
Issues: To properly instruct health team members to delve into the problems from
biologic, economic, social, anthropologic, cultural and emotional points of view.
To give new meaning to life story of people who lives with HIV/AIDS considering
the complexity of symbolic representations of their lives and infections and the
impact of these on each person and society
To achieve that HIV/AIDS infected people, assuming their health-illness process,
manage to plan alternative actions to accomplish different ways of life.
Description: Intendente Carrasco and Roque Saenz Pena hospitals are dependant on the Public Health Department of the City of Rosario, Province of Santa
Fe, Argentina. Both of them are medium complexity hospitals and work as base
for the district they belong to.
The changes in the evolutionary process of HIV/AIDS infection includes multiple
aspects of the patients life. Therefore the health team faces the problematical issues by means of an interdisciplinary work that allows to consider the population
as a whole. The impact of diagnosis, infection and illness in daily life of people
infected by HIV/AIDS is profoundly known thanks to every day work with them. A
group of peers is assembled to overcome this impact, achieve containment with
base in social relationships, give training for health promotion, help them in assuming their health-illness process and to increase health in the different circles
of community they are related to.
Lessons learned: This actions give greater dynamism in professional attention
circle, greater adhesion to treatment, and an open and enriching position to each
member of the group.
Recommendation: Promote team-work, beat theoretical-practical obstacles and
maximize material, human and economical resources to obtain a greater efficiency in treatment adhesion.
Presenting author: raquel noemi escobar, conscripto bernardi 6363 a, 2000 -
rosario, pcia. de santa fe, Argentina, Tel.: [phone], Fax: +54 (341)
464 4350, E-mail: [email protected]
ThPeF81 95 Patient-centered approaches to adherence to
highly-active antiretroviral therapy in resource poor
settings
C. Poole1, M.A. Chesney2, L. Mdani1, N. Dzazela, N. Nyatela, T. Kasper1
1Mddecins Sans Fronti~res, PO Box 27401, Rhine Road, Sea Point, 8050, South
Africa; 2University of California, San Francisco, San Francisco, United States
Background: High levels of adherence to highly-active antiretroviral therapy
(HAART) are necessary to achieve sustained suppression of viral replication.
Questions have been raised as to whether it is possible to achieve these levels in resource-poor settings, and it has been suggested that the only way to
successfully use HAART in such environments is with directly-observed therapy.
Methods: An adherence program was developed to support a HAART program
run by Medecins Sans Frontieres for patients with advanced HIV disease attending HIV clinics in three government-run primary health care centers in Khayelitsha, a poor township of Cape Town, South Africa. The program complements
other approaches to improving adherence (e.g., using a two-pill, twice-daily regimen). All patients participated in the program (85 to date; 15 new enroll per
month).
Results: The adherence program has three components: individual support (patients are requested to identify a "treatment assistant," typically a household
member, who can assist with adherence; trained counselors are available for
drop-in sessions), peer support (support groups exclusively for HAART patients
at which barriers to adherence and side effects are discussed; access to a resource center providing treatment materials), and material support (pillbox; chart
with drug identification, dosing, side effect and pillbox packing instructions; daily
schedule). To date 26 patients have completed six-month follow-up, of whom 24
have undetectable viral loads (92%), suggesting the success of the program. A
comprehensive adherence evaluation on the full cohort using a combination of
an adapted AIDS Clinical Trials Group questionnaire and clinic attendance will be
presented.
Conclusions: A patient-centered adherence approach that focuses on educating and involving those on antiretroviral therapy in their own treatment can lead to
successful treatment outcomes, even in a resource-constrained context.
Presenting author: Colwyn Poole, PO Box 27401, Rhine Road, Sea Point, 8050,
South Africa, Tel.: [phone], Fax: [phone], E-mail: colwynp
@ mweb.co.za
ThPeF8196 Understanding treatment in group

MS. Guimardes, J.C. Raxach, V. Terto Jr., R. Parker. Brazilian Interdisciplinary
AIDS Association, Rio de Janeiro, Brazil
Issues: Information and discussion of themes related to HIV/AIDS treatments.
Adherence isn't only understood as a simple act of taking pills. Political, social,
biological, psychological aspects and the network of support and services are
also included as major issues of discussions.
Description: The group was created one year ago at ABIA's office. Two hours

meetings are carried out once a week. The participants are mostly heterosexual
women and men who have sex with men. The age group varies between 26 and
52 years. The participative methodology is used to allow participants to associate
treatment to the issues that facilitate or hinder adherence. Despite information
dissemination is a major goal, the participants see the group as a support setting.
The activity is carried out by health professionals, who themselves are PWA.
Lessons learned: The personal experiences in coping with treatment are recognized as an encouragement for action, and not as "receipts" to be reproduced with
no reflection and no critics. The information must be clarified and discussed in a
way that it does not become an obstacle for adherence. Participation in groups
can be stimulating to raise awareness and to facilitate decision taking related to
treatment. The group assumes that adherence is an issue to be faced collectively
and not only an individual responsibility
Recommendations: This initiative reinforces the social and psychological network of support for PWA in Rio de Janeiro integrating health services and NGOs.
Along with other similar initiatives developed in the public health system and by
other NGOs, such groups are becoming references of low cost and well-accepted
activities that can be easily reproduced in different contexts, as well as improve
access and adherence to effective AIDS treatments.
Presenting author: Juan Carlos Raxach, Rua da Candeldria, 79, 10 andar, Centro - RJ, CEP - 20091-020, Rio de Janeiro, Brazil, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
ThPeF8197 Challenges in evaluating Living Well, a
community-based adherence support intervention
in East London, UK
C. Hattingh1, R. Brown2, C. Duggan3, P. Groom4, Y.S. Hoois, J. Kavanagh6,
S. Laut6, R. Melville7, J. Miller1, T. O'Keeffe7, R. Pratt8, V. Pribram9,
M. Sakupwanya4, H. Tan10. 1North East London Mental Health NHS Trust,
Psychology Dept, Goodmayes Hospital, Barley Lane, Goodmayes, Essex, IG3
8XJ, United Kingdom; 2Walthamstow, Leyton and Leytonstone NHS Primary
Care Trust, London, United Kingdom; 3Redbridge NHS Primary Care Trust,
London, United Kingdom; 4 Redbridge and Waltham Forest Health Authority,
London, United Kingdom; 5Barking, Havering and Redbridge NHS Hospital
Trust, London, United Kingdom; 6Havering NHS Primary Care Trust, London,
United Kingdom; 7'Whipps Cross University Hospital, London, United Kingdom;
8 Thames Valley University London, United Kingdom; 9Chingford, Wanstead and
Woodford NHS Primary Care Trust, London, United Kingdom; 10Ealing,
Hammersmith and Hounslow Health Authority London, United Kingdom
Issues: The recommended aim of 95% adherence to combination therapy
presents significant challenges to patients and healthcare workers. It is therefore
crucial to identify the most effective adherence support interventions. However,
ethical constraints and the complexity of community-based interventions may create obstacles to client-friendly, accurate evaluation.
Description: This paper highlights challenges and solutions in the evaluation
of the Living Well adherence support programme, established in East London
in 1998. Because lifestyle affects adherence, this community-based programme
responds to and improves participants' social context, rather than using clinicbased interventions. Health-care professionals provide information, then encourage and help clients to take the lead in creating a supportive social network.
Evaluating such a multi-faceted intervention has been a struggle. Ethical, practical and methodological constraints made it impossible to establish clear causal
links between interventions and outcomes. Cultural factors, literacy difficulties and
participant research fatigue hampered evaluation. Moreover, as the programme
developed, planned evaluation strategies became obsolete.
Lessons learned: Planning and implementing an evaluation strategy required
more resources than anticipated. A programme might have unexpected desirable
outcomes and there should be enough flexibility to reconsider which outcomes
should be measured. The continued participation of 75% of participants so far
has been our most rewarding outcome. These participants now attend and organise regular activities themselves. They form a supportive, sustainable local
community that relieves pressure on statutory services.
Recommendations: Care should be taken to make evaluation acceptable to participants. We aim to do this by using a new tool, developed by the Richard Wells
Research Centre, that takes account of our revised understanding of useful outcomes.
Presenting author: Charl Hattingh, Psychology Dept, Goodmayes Hospital, Barley Lane, Goodmayes, Essex, IG3 8XJ, United Kingdom, Tel.: [phone],
Fax: [phone], E-mail: [email protected]
ThPeF8198 Thinking outside the box: strategies to educate and
empower people living with HIV
B.D. Stanley, C. Jean-Gilles, V. Valentine. Virginia Commonwealth University,
Richmond, VA, United States

Issue: Increased drug resistance among HIV (+) patients due to lack of knowledge of medication and side effects.
Description: The Retozon Group (TRG), is a minority community-based organization advocating sexual wellness through adherence and prevention. TRG's services are provided at a relaxed, confidential, and centrally located off-site office
(away from medical environment). The program is designed to retain the patient
3-12 months depending on the patient's needs. TRG provides adherence educa