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COMPUTER ALERT SYSTEM AND TELEPHONE SUPPORT TO IMPROVE ANTIRETROVIRAL THERAPY ADHERENCE
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COMPUTER ALERT SYSTEM AND TELEPHONE SUPPORT TO IMPROVE ANTIRETROVIRAL THERAPY ADHERENCE

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  • 1. COMPUTER ALERT SYSTEM AND TELEPHONE SUPPORT TO IMPROVE ANTIRETROVIRAL THERAPY ADHERENCE Kasparas, Gustavo Guillermo (1); Iannella, María del Carmen (2);Bugarin, Gabriela (1); Miro, Roxana (1); Belforte, Marcela (1); Visciglio, Hugo (3); Bologna, Rosa (1); Cassetti, Isabel (1) Organization(s): 1: Helios Salud, Argentina; 2: Universidad de Buenos Aires; 3: Infhos. Contact e-mail: kasparas@fibertel.com.ar
  • 2. INTRODUCTION • Poor adherence to antiretroviral therapy (ART) is a major obstacle to successful treatment outcomes • There is evidence that telephone support improves adherence in several medical areas • In developing countries mobile phones are widely used • The registry of medication dispensed is an indirect method to assess adherence with acceptable sensitivity and specificity
  • 3. OBJECTIVES • To evaluate the efficacy of an adherence strategy based on a computer alarm system and telephone support intervention
  • 4. METHODS (I) Design: This is a retrospective intervention comparative cohort study. The comparator referred to is year 2006. In 2007 a newly installed computer alert system began to identify any delay of ART dispensing. Adherence strategies of telephone support were applied. Results for 2007, 2008 and 2009 were compared respect 2006. The rates of dispensed ART were compared as indirect indicators of adherence. Setting: This study was done at a private specialized medical center in Buenos Aires City and affiliates in the provinces where interdisciplinary HIV/AIDS attention is provided. Study population: The whole population in follow up was retrospectively studied from 2006 to 2009. At baseline, year 2006, there were 3,319 patients being followed up, mean age (SD) 37.0 (11.5) years, male 67.8%, ART 75.5%. In 2007 3,430 patients 37.3 (11.3) years, male 66.9%, ART 77.5%, in 2008 4,040 patients 37.7(11.2) years, male 67.7%, 76.5% on ART and in 2009 there were 4,584 patients, 38.4 (11.4) years, male 67.5%, ART 77.2%.
  • 5. METHODS (II) • Intervention: A computer program was designed to alert health staff about a delay in patient’s visit for medication dispense for the following period. Psychologists, social workers and peer support were trained to contact those patients by phone. • Outcome Measure: To assess efficacy of intervention in yearly rate of pharmacy dispensing with respect to the baseline.
  • 6. METHODS (II): Study Population TABLE 1. Medical Monitoring Population: 2006 to 2009 2006a N° of Patients 2007b 2008 2009 3,319 3,430 4,040 4,584 37.3 (SD11.3) 37.7 (SD11.2) 38.4 (SD11.4) Age, mean years 37.0 (SD11.5) With ART,% 73.2 75.5 76.5 77.2 Without ART,% 26.8 24.5 23.5 22.8 Male,% 67.2 66.9 67.7 67.5 a Year 2006: Baseline comparator b Year 2007: Start of the warning computer system and telephone support adherence to ART
  • 7. FLOW CHART OF THE INTERVENTION
  • 8. RESULTS (I) • The rate of medication dispensing visit showed a statistically significant increase with respect to baseline in 2007 (81.4%; 95% CI: 80.97-81.88; p = 0.001), 2008 (81.0%; 95% CI: 80.52 - 81.37; p = 0.004), 2009 (83.2%; 95% CI: 82.85-83.60, p < 0.001) and 2010 (88.9%; 95% CI: 88.33-89.40, p < 0.0001). • The rate of viral load < 50 copies/mL lab results showed a statistically significant increase with respect to the baseline. • The rate of CD4 T-cell count remained stable or slightly increased with no statistical significance.
  • 9. RESULTS (II)
  • 10. RESULTS (II) Table 2. HAART pick up rates, rates of studies VL <50 copies / mL and median CD4 cell count Year HAART pick up, % (95% CI) VL <50 copies / mL,%, (95% CI) CD4 cells / mL, median (IQR) 2006a 2007b 2008 2009 78.1 81.4 81.0 83.2 (77.58 - 78.59) (80.97 - 81.888) (80.52 - 81.37) (82.85 - 83.60) 53.7 59.6 62.7 69.3 (52.25 - 54.99) (58.24 - 60.88) (61.52 - 63.95) (68.17 70.36) 436 422 447 476 (292-615) (285-593) (306-616) (327-651)
  • 11. RESULTS (III)
  • 12. RESULTS (III) Figure 1. HAART pick up rates of pharmacy vs. Baseline (2006) Year Kasparas G et al. 2010 (First four months)
  • 13. RESULTS (IV)
  • 14. RESULTS (IV) Figure 2. Percentage of studies with VL <50 copies / mL Year
  • 15. POLICY IMPLICATION & CONCLUSION • Our findings show that centralized data of pharmacy dispensing, with a computer alarm for any delay and telephone support improves long-term adherence to ART and clinical outcomes. • Health policies that centralize computerized data and encourage the training of personnel may promote the replication of these interventions tailored to each culture. • This experience requires the work of members of different areas, which involves the development of teamwork skills. Supervision, coordination and training of the executors are necessary for this intervention in order to avoid losing the essence of "health intervention" to prevent becoming a purely administrative task without efficacy. • Mobile telephones are widespread, even in the poorest countries in the world. This gives health workers the opportunity to communicate with patients and thus strengthen adherence to treatment.
  • 16. MUCHAS GRACIAS Gustavo G. Kasparas Contact e-mail: kasparas@fibertel.com.ar