AEGiS-14IAC: Evaluation of a participative programme for the improvement of a global treatment of HIV-infected patients : Orchestra.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Evaluation of a participative programme for the improvement of a global treatment of HIV-infected patients : Orchestra.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. G12516)

Delpierre C, Voinet C, Koch BR, Cuzin L, Garbay MF, Hurlupe F, Revol I, Massip P
Hopital Purpan, Toulouse, France

ISSUES: Orchestra is the first French quality of care programme designed to improve global HIV disease management.

DESCRIPTION: Actions have been developed through a participative approach and were conceived to improve the information and training of healthcare providers, reception, orientation and education of patients, intra and extra-hospital healthcare providers coordination, psychosocial and nutritional management, treatment adherence.

ISSUES: Orchestra's evaluation was carried out by comparison of data collected before the programme implementation and 12 months later. A cohort study was implemented on a representative sample of patients. Main criteria were QoL (HIV-QL31 scale), patient satisfaction (evaluated through a specific scoring concerning 10 separate dimensions based on 66 items) and associated costs. 155 patients (mean age 45 and 78% male) were initially included. Their mean HIV history was 9 years, 88% had a tritherapy, 19.3% had AIDS. Serum HIV-1 RNA average level was 7 500 copies and average CD4 cell count was 470 x 106 cells/l in M0. Corresponding values were 4 100 copies (p=0,03) and 485 x 106 cells/l (p=NS) in M12. The mean global score on the HIV-QL31scale revealed a very positive perception of life from patients in M0 as in M12 (1.85 ± 0.15 on a scale from 1 to 2 in both cases). Concerning the patient satisfaction assessment, results showed a significative improvement of health care coordination (p<0,001), reception and confidentiality (p<0,001), communication (p<0,001), treatment education (p<0,001), information (p< 0,001), sexual dysfunctions care (p=0,01), nutritional care (p<0,001), psychological care (p=0,02), social assistance (p<0,01). Finally, costs associated to the ORCHESTRA implementation appeared to be very low from a hospital point of view and few changes were observed between M0 and M12 on costs of care.

RECOMMENDATIONS: Orchestra's approach had very positive consequences and could be implemented in other settings.

Keywords: AEGIS, HIV Infections, Evaluation Studies, Acquired Immunodeficiency Syndrome, CD4 Lymphocyte Count, HIV Seropositivity, Antiretroviral Therapy, Highly Active, Patient Satisfaction, Cohort Studies, Costs and Cost Analysis, Male, Human, therapy, Education, economics, drug therapy

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G12516