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[ Recorded presentation ] Recorded presentation

Using a Clinic-Based Intensive Case Management Model to Overcome Barriers to Adherence to Highly-Active Antiretroviral Therapy (HAART) in Los Angeles County, California

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 patientís 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:

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 ] Recorded presentation

HIV/AIDS Treatment Adherence

The 132nd Annual Meeting (November 6-10, 2004) of APHA