Recorded presentation

Amy R. Wohl, MPH, PhD¹, Wendy H. Garland, MPH¹, Susan Cheng, MPH¹, Jonaas Walton¹, Kathleen Squires, MD², Mallory Witt, MD³, Andrea Kovacs, MD², Robert Larsen, MD², Paul Weidle, PharmD, MPH⁴, and Shannon Hader, MD, MPH⁴. (1) Los Angeles County Department of Health Services, HIV Epidemiology Program, 600 S. Commonwealth Ave., Suite 1920, Los Angeles, CA 90005, 323-258-8022, wgarland@dhs.co.la.ca.us, (2) LAC/USC Medical Center, 1300 N. Mission Road, Los Angeles, CA 90033, (3) Harbor/UCLA Medical Center, 1000 W. Carson St., Torrance, CA 90501, (4) Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop E-45, Atlanta, GA 30333

Issues: Case management models have been used to improve patient access to medical care and overall quality of life; however, there has been limited research on their utility in improving adherence to HAART. We describe experience with a case management model to improve adherence to HAART by reducing psychosocial barriers. Description: The Intensive Adherence Case Management (IACM) program is part of an ongoing randomized trial of 3 adherence support models in 3 public HIV clinics in Los Angeles County. The IACM program includes a comprehensive psychosocial assessment conducted by a trained, bilingual case manager (CM) and an individualized adherence plan (IAP) developed by the CM, patient and the patient’s provider. The CM and patient meet at least weekly for 6 months to address concrete needs, evaluate progress with IAP goals, and adherence. Lessons Learned: Since November 2001,72 patients have been enrolled in the IACM (67% Latino, 25% African-American; 72% male; 58% Spanish-speaking; 63% annual income <$10,000; 46% age 30-39). The 40 patients who have completed the intervention to date kept 76% of their scheduled weekly contacts with their CM and met 74%(137/184) of the adherence goals established in their IAP. The most common goals identified were related to housing (13%), adherence (12%), legal issues (12%) and nutrition/food (11%). Recommendations: Preliminary findings suggest that a clinic-based intensive adherence case management model has the capacity to help clients address and reduce a range of barriers to adherence. Further study of the impact of IACM on adherence measures is needed.

Learning Objectives:

2. Describe the elements of an intensive case management program to reduce barriers to adherence.
4. Apply elements of an intensive adherence case management program to exisiting adherence support services.

Keywords: Case Management, Antiretroviral Combination Therapy

Presenting author's disclosure statement:
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.

Recorded presentation