Background: Ensuring adherence to HIV medications is a challenge in primary care. For populations with multiple barriers to care, achieving high levels of adherence is an even greater challenge. Description: in 1997, Dimock Community Health Center (DCHC) developed a multidisciplinary comprehensive adherence program integrated into a Ryan White-funded CHC HIV primary care clinic to ensure that Highly Active Antiretroviral Therapy (HAART) is Highly Effective ART (HEART) through access to HIV quality care, nurse educators/case managers, peer advocates, on-site wrap-around services (mental health, substance abuse), development of a literacy and linguistically appropriate treatment manual, and program evaluation. In 1999 through SPNS funding, we added an evaluation of impact of home-based adherence and cost effectiveness of the program. Results: The program has enrolled >75% of patients on HAART (PoH). The pts are 85% minority, 40% women with high rates of comorbid conditions. In 2000, the 2 peers saw 50 clients (40% of PoH) with >100 contacts/month. The program has been replicated in 1 CHC and a 2nd site is in progress. Pre program, 42% of PoH had undetectable viral loads (BDL) at 1 year. In 1999, >90% of PoH with BDL remained undetectable >1 year. Data collection on adherence, effectiveness and cost is ongoing Conclusions: A one-stop, multidisciplinary and multicultural adherence support program can be incorporated into primary care. The program involves all providers and is responsive to changing needs of patients and treatments. HAART to HEART is reproducible in similar settings. Evaluation of home-based and other program components is ongoing.
Learning Objectives: 1. To describe a multidisicplinary community health center-based adherence program 2. To identify key components of integrated HIV primary care adherence support 3. To apply knowledge to clinical program design for adhernece support in clinical settings
Keywords: Adherence, Community Health Centers
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.