Background: With adequate adherence, antiretroviral (ARV) medications increase life expectancy and improve quality of life. Offering ARVs to the urban poor is controversial due to fears of low adherence and the concerns of inadvertent transmission of multiple drug resistant HIV. Methods: We developed a storefront program (Action Point) offering nursing service, medication management, case management and acupuncture to homeless and marginally housed (urban poor) in SF. Clients come as often as daily. A web based paging system is used to notify clients of medication schedule, and a financial incentive is given for weekly participation. Biologic data were gathered from patient records. Results: In the first 3 months, 68 clients enrolled. 67 (98%) had a drug use history, 25 (37%) were homeless and 41 (60%) were taking ARVs. 63 clients enrolled with recent viral loads (14 (22%) <500, 19 (30%) 501-10,000, 16 (25%) 10,001-50,000, 14 (22%) >50,001 copies/ml). After 5 months, 42 (67%) continue to present weekly for services. 5/42 (12%) remain homeless. 35 (83 %) are on HAART. 25 (52%) had a follow-up HIV RNA (VL) result at least two months after enrolling. 8/25 (32%) clients had a VL less than 500 copies/ml upon enrollment that increased to 15/25 (60%) with a VL less than 500 after 5 months. Conclusions: We retained urban poor clients at a cost per client similar to a single protease inhibitor. Preliminary results show significant clinical benefit. With adherence support, the urban poor can benefit from ARVs at a rate similar to other populations.
Learning Objectives: Attendees will understand the risks and benefits of offering HIV+ people living with poverty and systems that assist muliply diagnosed individuals to adhere to combination therapy
Keywords: Adherence, Homeless
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
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.