AEGiS-NHIVPC: Multi-Tiered Adherence Model in the Treatment of HIV

National HIV Prevention Conference

Atlanta, Georgia, USA — July 27 - 30, 2003

Multi-Tiered Adherence Model in the Treatment of HIV

Natl HIV Prev Conf 2003 July 27-30:abstract no. M1-F0103
Garcia F
Texas Association of Community Health Centers, Texas, TX

BACKGROUND: Motivating patients to comply with medication regimen is a challenge for the Health Care Professional. It has been proven that adherence leads to the success of HIV therapy in HIV positive patients. HIV infected patients in the South Texas US/Mexican Border will be able to participate in a multilevel structured treatment project to assure that patients are receiving the most appropriate level of care thus increasing adherence and reducing cost. This process is a four tiered system ranging from Acute Risk to Self-Managed care.

METHOD: Upon entry in the study, patients will be assessed by the physician and placed in one of the following levels of care.

Level 1: Acute Risk Management: This client will or has established a history of no-shows and medically non-compliance with regard to treatment regimes. Additionally, this client does not pick up medications in a timely manner.
Level 2: Agency Management plus Enhanced Care: This patient will exhibit a lesser degree of acuity than that of the acute risk client. This client is consistent with appointments and demonstrates a positive response to enhanced care over the agency-managed client. This system will allow for a higher level of education with regard to medication, co-morbidity's and case management.
Level 3: Agency Management: This is the control group. This is the current standard of care with visits every 3 months and the average visit being 45-60 minutes in length. As a rule, this patient is compliant with adherence issues and exhibits no special needs.
Level 4: Self-Management: This client is doing very well and exhibits a high level of understanding and acceptance of HIV. This client is active in the learning process and requires a lessor demand for medical care and/or case management. Other criterion includes stability of disease process, independent functioning and complies with treatment regimen.

All persons regardless of level will be evaluated every 3-6 months for appropriateness in the level of care selected by the patient and physician. Evaluation will include but is not limited to behavioral evidence (i.e. picking up medications in a timely fashion, attending clinic appointments, taking medications, etc.), client interview, VAC Adherence Profile and lab results. David Barney Ph.D. of the University of Oklahoma, Norman, Oklahoma, will evaluate this project. The IRB for this study has already been approved.

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M1-F0103