The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #69249

Ruth Finkelstein, ScD¹, Lois Eldred, DrPH², Ricardo Alvarez, MD³, G. Stephen Bowen, MD, MPH⁴, Adan Cajina, MS⁵, Theresa Cassidy, MPH¹, Daniel D. Ciccarone, MD⁶, John Dougherty, PhD⁷, Barbara Hanna, MD⁸, Lisa R. Hirschhorn, MD, MPH⁹, Mary K. Irvine, MPH¹⁰, Sharon B. Mannheimer, MD¹¹, Joanne E. Mantell, PhD, MSPH¹, Richard Moore, MD¹², Rajat Mukherjee, MS¹, Linda M. Mundy, MD¹³, Emily Richie, MD¹⁴, Mark Waters, RN, MPH¹⁵, and Tracey E. Wilson, PhD¹⁶. (1) Office of Special Populations, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, (212) 822-7266, rfinkelstein@nyam.org, (2) Chief, Demonstration Project Development and Evaluation Branch, HIV/AIDS Bureau, HRSA, USDHHS, 5600 Fishers Lane, Room 7C-07, Rockville, MD 20857, (3) Mission Neighbor Health Center, 240 Shotwell Street, San Francisco, CA 94110, (4) Executive Director, Epidemiology, North Broward Hospital District, Ft. Lauderdale, FL 33316, (5) Department of Health & Human Services, Health Resources & Services Administration, HIV/AIDS Bureau, 5600 Fishers Lane, Rm 7C07, Rockville, MD 20857, (6) Urban Health Study, Department of Family and Community Medicine, University of California, San Francisco, 3180 18th Street, Suite 302, San Francisco, CA 94110, (7) Multnomah County Health Department, 426 West Stark Street, Portland, OR 97204, (8) AIDS Services Center, Inc., 608 Martin Luther King Drive, Anniston, AL 36202, (9) Dimock Community Health Center, 55 Dimock St, Roxbury, MA 02119, (10) Center for Applied Public Health, Mailman School of Public Health, Columbia University, 722 West 168th St., 10th Floor, New York, NY 10032, (11) Harlem Hospital Center, Columbia University College of Physicians and Surgeons, 506 Lenox Avenue rm 3101-A, New York, NY 10037, (12) Johns Hopkins University School of Medicine, 1830 East Monument Street, Rm. 8059, Baltimore, MD 21287, (13) Medicine, Washington University School of Medicine, 660 S. Euclid, Campus box 8051, St. Louis, MO 63110, (14) Chase Brexton Health Services, Inc., 1001 Cathedral Street, Baltimore, MD 21201, (15) Office of the Medical Director, New York State Department of Health AIDS Institute, 5 Penn Plaza, New York, NY 10001, (16) Preventive Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY 11203

Background: Many programs to support adherence to HAART have been implemented, but little is known about their effectiveness for specific populations and their dose. To address these issues, HRSA's SPNS funded 12 adherence support programs and the NY Academy of Medicine to evaluate them. Objectives: To determine the effectiveness of different adherence support programs in increasing HAART adherence. Methods: Clients were interviewed six times over 18 months. Service encounter data were collected to document adherence support. Descriptive program-level variables were constructed from site assessments. Longitudinal techniques were used to predict changes in self-reported adherence between baseline and six months later, with client service encounters treated as a co-variate. Results: Out of 2,623 clients who completed a baseline interview, to date 478 clients completed their first two quarter interviews and were included in a longitudinal analysis. The analysis sample and the entire cohort have comparable demographics, and reveal a cohort that is 69% black, 62% male, 61% with at least a high school education, with a mean age of 40.5. Conclusions: Preliminary analysis of the effectiveness of different program models show (1) a “readiness” component significantly helps clients maintain high levels of adherence when they start medications; (2) intervention programs based on Prochaska’s Stages of Change Model are successful in improving clients’ adherence over the six-month period; (3) no direct relationship between the intensity of encounters and improvement in adherence; and (4) specific services like medication pick-up and clinical care had positive impact on adherence over time.

Learning Objectives:

• To determine the effectiveness of different adherence support programs in increasing HAART adherence

Related Web page: case.nyam.org

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: New York Academy of Medicine, NY, NY Chase Brexton Health Center, Baltimore, MD Mailman School of Public Health Columbia University, NY, NY Dimock Community Health Center, Roxbury, MA Harlem Hospital Center, NY, NY Health Research, Inc. (NY
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.

Handout (.ppt format, 222.0 kb)