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

XIV International AIDS Conference

Abstracts ThPeF8199-ThPeF8202 633

tion to patients prior to starting antiretroviral therapy (ART), and to patients who
failed ART for the first time. In addition, each patient is educated on safer sex
activities, and proper application of prevention barriers to avoid transmission of
HIV and other STDs. TRG also interacts with providers and community leaders
to relay the concerns of the patients so that barriers such as cultural competency, confidentiality, discrimination, ethnic beliefs and socio-economic concerns
are addressed.
Lessons Learned: In a private and confidential setting, away from the medical
site, the patient is more relaxed, unhurried, undisturbed, and more apt to learn
and understand their disease process. Patients are attentive and eager to learn
about medications and side effects. By taking the patient through a series of
lessons over an extended period of time, the patient becomes more incline to
adhere to the medication regimen. The patients learn: adherence means not only
a longer life, but also a better quality of life. The patients are especially grateful
that they will be able to actively participate in their medical care and be a part of
the decision making in drug selections.
Recommendations: TRG will continue to provide adherence education in a relaxed, confidential environment conducive to learning, thereby, reducing drug resistance through adherence to medical regimens.
Presenting author: bettye stanley, 5001 w. broad st., suite 307, richmond, virginia, United States, Tel.: [phone], E-mail: [email protected]
ThPeF8199 Medical adherence in HIV+ communities of color
L.M. Pooser. New Jersey Medical School, Irvington, NJ, United States
Issues: Patients that actively participate in their medical management are more
adherent to medications and treatment regimens than those who do not. In HIVpositive individuals imperfect adherence is a special concern. Strict compliance
to the complex regimen of HAART has been proven to maintain suppression of
HIV replication, optimize immunologic function and ultimately improve disease
prognosis. It is therefore imperative that we investigate the issues of patient noncompliance and develop practical strategies to overcome them.
Description: "Putting A Face on HIV" is a series of interactive educational seminars designed to educate HIV positive patients on issues relevant to the medical
management of their disease. Through the use of multimedia, role-playing and
peer education, the seminars covered topics such as the life cycle of the Human
Immunodeficiency Virus, antiretroviral medications, adherence skills, clinical trials
and ways in which to improve physician-patient communication. Upon completion
of the program, participants were revisited in order to assess the long term efficacy of the program.
Lessons Learned: Upon evaluation of the of the seminars it became evident
that it was possible to empower HIV positive patients to take an active role in
medical treatment decisions through the implementation of a culturally sensitive,
population specific seminar series. This increased level of patient involvement
led to improved antiretroviral and medical adherence and suggested an improved
prognosis.
Recommendations: It is recommended that clinical centers institute a type of
program that is tailored to the specific needs of the population that it serves. Moreover, upon completion of the initial phase of the program there must be follow-up
with intermittent educational refresher sessions in order to sustain results over
the longer term.
Presenting author: leslie pooser, 1787a manor drive, irvington, new jersey,
United States, Tel.: [phone], E-mail: [email protected]
ThPeF8200 Treatment adherence counselor improve adherence
in severe non-adherent patients
A. Carmona1, H. Knobel1, J.L. Casado2, R. Lopez3, E. Condes 4, C. Buendia5,
R. Sabido6. 1Hospital del Mar, Dept Pharmacy, Hospital del Mar, Paseo
Maritimo 25-29, Barcelona. 08003, Spain; 2Hospital Ramon y Cajal, Madrid,
Spain; 3Hosptal VaIl dHebron, Barcelona, Spain; 4Hospital de Mostoles,
Mostoles, Spain; 5Hospital Virgen del Rosell, Cartagena, Spain; 6Hospital
Ramdn y Cajal, Madrid, Spain
Background: Effectiveness of antiretroviral therapy may be limited by poor adherence. Non-adherent patients should be enhanced to improve their adherence
condition and therapy outcomes. Objective: To assess the improvement of adherence in severe non-adherent patients (SNAP) who received continuous and
personalised counseling by a treatment adherence counselor (TAC).
Methods: Subgroup analysis of a prospective, multicentric (69 hospitals), nationbased survey of 3004 patients who started HAART including nelfinavir from 12'98
to 01'00. Group A: conventional care; Group B: conventional care + TAC (pharmacist or a nurse). All patients fulfilled a simplified medication adherence questionnaire (SMAQ) at baseline, and after 3, 6, and 12 months. If the patient showed
bad adherence, the TAC gave him personalized counsel in order to improve adherence. Our study was performed in SNAP (self-report adherence < 70%).
Results: Group A: 1628 patients, 186 (11%) SNAP at month 3. Group B: 1376

patients, 133 (10%) SNAP at moth 3. Baseline characteristics were similar in
both groups (mean age: 34 years; male: 76%; IDU: 80%; AIDS: 41%; naives:
20 %; median CD4 cell count: 240/ml; median viral load: 4,77 Iog/ml). At month
12 of follow-up: Adverse events (A:19% - B:16%); progression or death (A:21%B:16%); loss of follow-up (A: 15%- B:22%) was observed without significant difference in both grroups.Only 82 (44,1% SNAP group A) and 62 (46.6% SNAP group
B) continued treatment at month 12. Improvement of adherence (adherence >

90%) was achieved in 46 (56,1%) group A, and 46 (74.2%) group B (p = 0,02).
Effectiveness (VL< 500copies/mL) was observed in 27 patients (32,9%) group A
and 28 (45.2%) group B (p = 0,1).
Conclusions: The intervention of a TAC is very useful in improving adherence of
SNAP. It is important to identify this kind of patients to give them extra counsel in
order to become good adherents and improve therapy outcomes.
Presenting author: Alexia Carmona, Dept. Pharmacy, Hospital del Mar, Paseo
Maritimo 25-29, Barcelona. 08003, Spain, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
ThPeF8201I Treatment and care support foundin the model of
attitude, medications, exercise, and nutrition
(amen)
V. Hernandez. Columbia University, Brooklyn, NY, United States
Issues: For many persons living with HIV/AIDS finding peer support environment
that encourages self and collective adherence to ARV therapies and HIV/AIDS
care requirements is a challenge. Some of the challenges are: finding a proactive
group that has processed much of the emotional barriers and wants to execute
constructive action steps toward health and wellness; a group that speaks to one's
own particular socio- economic, cultural, gender, sexual, and spirtual values and
identity Finding a group to share the burden of living with HIV and find balance as
well as comradery in finding a quality of life with HIV/AIDS can present a unique
obsticle.
Description: Attitude, Medications, Exercise and Nutrition (A.M.E.N.) is a model
that was piloted in southern California for persons living with HIV/AIDS. This program, now duplicated in several cities throughout the U.S., takes into consideration the attitude needed to approach the medications, exercise and nutrition element that are part of a whole strategy of living successfully with HIV/AIDS. The
program is for persons living with HIV/AIDS who want to take a proactive approach to treatment and care in a collective setting. The cohort provides the ARV
and therapy information, experience and perspective, mental and spiritual health
and social skills support that comes to be unique and proves successful to the
group. The outcomes and impact have been very profound and have encouraged
many to participate.
Lessons learned: You cannot live or fight HIV/AIDS alone. Finding the persons
who are kin, to support one through the process to be adherent to therapy, care,
and preventative measures, mental and spiritual health is a key to a successful
quality of live with HIV/AIDS.
Recommendations: The A.M.E.N. formula should be encouraged and tailored
to respective community needs that empowers persons to become their own primary healthcare advocates and supports a high quality of life for people living
with HIV/AIDS.
Presenting author: vic hernandez, 123 Java Street, brooklyn, ny 11222, United
States, Tel.: [phone], Fax: [phone], E-mail: [email protected].
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ThPeF8202 Expanded role of the pharmacist in HIV/AIDS care
C.D. Turner. Cool Aid Community Health Centre, Victoria, BC, Canada
Issues: Medication regimens for the treatment of HIV can be complex and cause
adverse effects. Improved medication adherence enhances CD4 and viral load
responses and decreases opportunistic infections, drug resistance and mortality This has been shown with the use of directly observed or maximally assisted
therapy in the treatment of both HIV and tuberculosis. Adherence is difficult for
patients who face other significant health and social problems such as addiction,
hepatitis C, psychiatric disorders and homelessness.
Description: At our clinic in Victoria, we treat many HIV positive clients who face
those issues. Our clinic received funding in 2001 to provide services from physicians, nurses in expanded roles, a pharmacist, a nutritionist and an alcohol and
drug counselor. This "one stop" model enables clients to access a variety of services in an environment where they feel accepted and trust the staff. Prior to the
expansion of the clinic, clients could not access these services in one centre. In
addition, antiretrovirals were only dispensed from an outpatient pharmacy at the
local hospital where pharmacists do not have access to medical records. Those
clients pick up medications every one or two months so problems are not always
detected and communicated in a timely manner.
Lessons learned: The pharmacist at our clinic functions as part of a multidisciplinary team. For clients starting on a new antiretroviral regimen, medications
are dispensed in weekly blister packs or dossettes. By seeing clients weekly, a
rapport is built and close monitoring of adherence, laboratory data and adverse
effects is possible.
Recommendations: A case series will be presented of HIV positive clients who
previously accessed health care or medications on an "urgent" or "crisis" basis
and now actively participate in routine standard of care practices. Clinical data
supports the positive outcomes through increased CD4 levels, lower viral loads

and fewer serious illnesses.
Presenting author: Charmaine Turner, 465 Swift St, Victoria, BC, V8W 1S2,
Canada, Tel.: [phone], Fax: [phone], E-mail: pharm
@coolaid.org