ICAP Adherence Data<br />Molly McNairy, MD, MSc<br />Supporting Sustainable Adherence to HIV Prevention, Care & Treatment<...
To Review<br />Patients on ART in resource-limited settings can have good immunologic and virologic outcomes<br />Rates of...
Meta-Analysis:  Adherence at 2 years<br />Rosen et al.  PLoS 2007<br />32 studies in SSA 1996-2007<br />~75,000 patients i...
A closer look at ICAP<br />Adherence Data June 2009<br />URS, PFaCTS, Patient-level<br />“Those are other programs”<br />
Data Sources<br />URS data<br /><ul><li>LTFU varies across countries
Often means 90 days since last visit</li></ul>Patient-level data<br /><ul><li>LTFU from care = 12 months since last clinic
LTFU from treatment= 6 months since last clinic</li></ul>PFACTs<br /><ul><li>Adherence program characteristics</li></li></...
Two-year cumulative risk of death, loss to follow-up9, and loss to program8among ART patients since ART initiation (Total ...
Pediatric ART patients since ART Initiation <br />Patient level  data through June 2009 (n= 28 sites)<br />
Applying the Meta-Analysis ResultsTo ICAP Adherence Data <br />“Good Adherence&gt;95%”<br />Our GAP<br />*Rosen et al PLoS...
Cumulative and current enrollment in ART care <br />at ICAP-supported HIV care and treatment programsas of June 2009 (n= 3...
Status of ART patients at ICAP sites<br />June 2009 (n= 327,092)<br />10.3% per year on ART<br />Lost to Follow-up<br />5....
PFaCTS Data on Adherence services <br />Type of patient support service<br />Type of adherence service<br /># outreach wor...
Sites offering on-site patient support services  (n=323)<br />Take Home:  All sites have services, but what are those serv...
64%<br />
Mean number of outreach workers <br />at ICAP-supported HIV care and treatment sites (n=183)<br />Mean number of outreach ...
Number of outreach workers per 1,000 active ART patients at ICAP sites with at least 1 dedicated outreach worker,PFaCTS Ro...
Prevention Services Offered at ICAP Sites<br />% sites<br />
Time between missed appointment and contact attempt for ART patients<br />PFaCTSRound 4 (Jan-Jun 2009)<br />
Measuring Adherence to Treatment<br />Lack of ICAP structured measurement tools<br />Difficult to measure<br /><ul><li>Pat...
Lost to treatment program & treatment interruptions
Clinical records
Upcoming SlideShare
Loading in...5
×

What Do We Know About Adherence in ICAP Programs?: A Review of the Data

1,073

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
1,073
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
13
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

What Do We Know About Adherence in ICAP Programs?: A Review of the Data

  1. 1. ICAP Adherence Data<br />Molly McNairy, MD, MSc<br />Supporting Sustainable Adherence to HIV Prevention, Care & Treatment<br />ICAP Technical Workshop<br />October 19-22, 2009Kigali, Rwanda<br />
  2. 2. To Review<br />Patients on ART in resource-limited settings can have good immunologic and virologic outcomes<br />Rates of adherence and barriers to adherence similar across settings<br />LTFU increases over time<br /><ul><li>(5X higher > 2-3 years)</li></ul>LTFU relationship with mortality<br /><ul><li>40-50% of LTFU  dead</li></ul>Rosen 2007, McPherson 2008<br />
  3. 3. Meta-Analysis: Adherence at 2 years<br />Rosen et al. PLoS 2007<br />32 studies in SSA 1996-2007<br />~75,000 patients in non-research ART <br />6 mo = 80% pts retained<br />12 mo = 60% pts retained<br />At 2 Years*:<br />BEST CASE = 84% <br />WORST CASE = 46%<br />AVERAGE = 61%<br /> ~40% LTFU at 2 years<br />Of which, LTFU 56%, Death 40%<br />61% at 24 months<br />
  4. 4. A closer look at ICAP<br />Adherence Data June 2009<br />URS, PFaCTS, Patient-level<br />“Those are other programs”<br />
  5. 5. Data Sources<br />URS data<br /><ul><li>LTFU varies across countries
  6. 6. Often means 90 days since last visit</li></ul>Patient-level data<br /><ul><li>LTFU from care = 12 months since last clinic
  7. 7. LTFU from treatment= 6 months since last clinic</li></ul>PFACTs<br /><ul><li>Adherence program characteristics</li></li></ul><li>Application for ICAP Sites<br />Two-year cumulative risk of death, loss to follow-up9, and loss to program8among all patients since enrollment into care (Total 204,000)<br />WORST CASE SCENARIO:<br />204,000 patients<br />50% at 2 years<br />100,000 patients LTFU?<br />
  8. 8. Two-year cumulative risk of death, loss to follow-up9, and loss to program8among ART patients since ART initiation (Total 91,612 patients)<br />
  9. 9. Pediatric ART patients since ART Initiation <br />Patient level data through June 2009 (n= 28 sites)<br />
  10. 10. Applying the Meta-Analysis ResultsTo ICAP Adherence Data <br />“Good Adherence&gt;95%”<br />Our GAP<br />*Rosen et al PLoS Med 4 (10) 2007<br />
  11. 11. Cumulative and current enrollment in ART care <br />at ICAP-supported HIV care and treatment programsas of June 2009 (n= 327,092)<br />Cumulative initiating ART<br />Lost to follow up<br />Reported dead<br />Number of patients<br />ART patients retained in care<br />
  12. 12. Status of ART patients at ICAP sites<br />June 2009 (n= 327,092)<br />10.3% per year on ART<br />Lost to Follow-up<br />5.3% per year on ART<br />Reported Dead<br />.59% per year on ART<br />Stopped ART<br />*Includes patients who transferred out while on ART.<br />
  13. 13. PFaCTS Data on Adherence services <br />Type of patient support service<br />Type of adherence service<br /># outreach workers <br />Methods for tracking missed appointments<br />Time to follow-up/tracking<br />
  14. 14. Sites offering on-site patient support services (n=323)<br />Take Home: All sites have services, but what are those services doing?<br />% sites with service<br />
  15. 15. 64%<br />
  16. 16.
  17. 17. Mean number of outreach workers <br />at ICAP-supported HIV care and treatment sites (n=183)<br />Mean number of outreach workers<br />
  18. 18. Number of outreach workers per 1,000 active ART patients at ICAP sites with at least 1 dedicated outreach worker,PFaCTS Round 4 (Jan-Jun 2009)<br />n=8<br />n=48<br />n=18<br />n=11<br />n=17<br />n=39<br />n=8<br />n=33<br />n=207<br />n=24<br />n=1<br />Note: The bubbles represent the median across sites and the bars represent the IQR.<br />
  19. 19. Prevention Services Offered at ICAP Sites<br />% sites<br />
  20. 20.
  21. 21.
  22. 22. Time between missed appointment and contact attempt for ART patients<br />PFaCTSRound 4 (Jan-Jun 2009)<br />
  23. 23. Measuring Adherence to Treatment<br />Lack of ICAP structured measurement tools<br />Difficult to measure<br /><ul><li>Patient level
  24. 24. Lost to treatment program & treatment interruptions
  25. 25. Clinical records
  26. 26. Patient self-report, pill count, recall
  27. 27. Surrogate measures
  28. 28. Treatment failure
  29. 29. Second line regimens</li></li></ul><li>Proportion of patients with CD4 count at baseline, 6, and 12 months after ART initiation<br />% patients with CD4 count<br />n=8,497<br />n=9,921<br />n=7,420<br />n=13,420<br />n=25,854<br />n=10,683<br /> n=9,557<br />n=29,342<br />n=114,694<br />
  30. 30. Proportion of adult ART patients on second line regimens in ICAP supported care and treatment sites, June 2009 <br />Note: Restricted to sites that report &gt;=90% of regimen data<br />
  31. 31. In Summary<br /><ul><li>LTFU is a complicated term
  32. 32. ICAP has LTFU rates similar to other large ARV programs
  33. 33. 40% ART pts LTFU at 2 years (worst case)
  34. 34. Yet, ICAP has >98% of sites reporting adherence programs and multi-level pt support services
  35. 35. > 75% sites report counseling more than 1 month, dedicated adherence pharmacist, and remember/education tools
  36. 36. >85% of sties report having appointment registers
  37. 37. > 70% sites report capacity for patient tracking with phone calls, home visits
  38. 38. Average of 6 outreach workers/1000 ART patients</li></ul>How can we strengthen our adherence support services?<br />
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×