This study evaluated the efficacy of a computer alert system and telephone support intervention to improve adherence to antiretroviral therapy. The intervention included a computer program that alerted staff about delays in medication dispensing, and trained psychologists contacted patients by phone. Compared to 2006 baseline, medication dispensing rates significantly increased in 2007, 2008, 2009 and 2010. Viral load suppression rates also significantly increased compared to baseline. CD4 cell counts remained stable or increased slightly but not significantly. The findings showed centralized data, computer alerts, and telephone support can improve long-term adherence and clinical outcomes for antiretroviral therapy.

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