Health
Services Center
(formerly AIDS Service Center)
Barbara J. Hanna, MD
P.O. Box 1392
Anniston,
AL 36202
(256) 832-0100
Project
Period: 10/99 – 9/02
Target
Population: People with HIV
who are poor and uninsured and
who live in rural northeast Alabama,
many of whom are African American
Description:
Health Services Center (ASC) provides
HIV care to people with HIV/AIDS
in a predominantly rural 14-county
area of northeast Alabama. The
adherence program ASC has developed
provides three different interventions,
including a modified directly
observed therapy intervention,
that differ in intensity to meet
the specific need of the client.
The baseline interview is used
as a screening tool to assess
which of the three interventions
is most appropriate for each client.
Clients enrolled in the most intense
intervention have been paired
with a trained buddy or buddy
team. The buddy makes contact
with the client daily by phone,
and provides support for taking
his or her medication. Clients
enrolled the directly observed
therapy intervention come to either
ASC or a local health department
five days a week to pick up their
medications. Clients enrolled
in the least intense interventions
meet with a clinic adherence panel
monthly at the time of their clinic
visits. Periodic reevaluation
occurs, and if the needs of a
client change, s/he can be moved
to a different level of intervention.
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Chase
Brexton Health Services, Inc.
Emily Richie, MD
1001 Cathedral Street
Baltimore, MD 21201
(410) 837-2050 x215
Project
Period: 10/99 – 9/02
Target
Population: People with HIV
who are substance users or at
high risk for depression, including
women
Description:
Chase Brexton Health Services,
Inc. (CBHS), a large comprehensive
community-based provider of primary
HIV care to underserved populations
in Maryland, has recently developed
a system-wide comprehensive program
designed to improve client adherence
to HAART regimens. Central components
of the adherence program are:
periodic screening for substance
use and depression risk for early
intervention and follow-up; proactive
multi-departmental coordination
of intervention plans and follow-up
for those identified as high risk;
and, standardization and integration
of HAART education and other adherence
support into the care provided
by CBHS. The goal is to develop
new standards for provision of
HAART and adherence support for
substance users and those at high
risk for major depression.
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Dimock
Community Health Center (DCHC)
Lisa Hirschhorn,
MD, MPH
55 Dimock Street
Roxbury, MA 02119
(617)
442-8800 x1255
hirschhorn@mediaone.net
Project
Period: 10/99 - 9/02
Target
Population: People with HIV,
including women, African Americans,
Hispanics,
and people who have problems of
mental health and/or substance
use.
Description:
The adherence project at the Dimock
Community Health Center works
to ensure treatment with and adherence
to HAART for HIV infected
individuals, comparing a standard
adherence strategy to an intensive
strategy that involves community-based
care. Patients are randomly assigned
to receive either
the standard or the intensive
strategy. The standard strategy,
which includes multidisciplinary
care as coordinated by an HIV
nurse, HIV specialty care, use
of
literacy-leveled educational materials,
peer counseling, use of a programmable
watch, and tailored interventions,
is provided at both study sites.
In the intensive
strategy, an HIV home care nurse
also visits patients once or twice
weekly for four to six weeks in
their identified community setting,
addressing specific
barriers to adherence in coordination
with the multidisciplinary team.
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Columbia
University Harlem Hospital Center
Sharon
Mannheimer
506 Lenox Avenue, Room 3101-A
New York, NY 10037
212-939-2948
sbm20@columbia.edu
Project
Period: 10/99 – 9/02
Target
Population:
The Harlem Adherence Treatment
Study (HATS) is a study that randomly
assigns subjects to either a group
that receives an enhanced adherence
intervention or the current clinical
practice for adherence. The experimental
(enhanced) intervention consists
of two main components: peer-centered
social support and assistance
in overcoming barriers to adherence.
The intervention is based on the
Transtheoretical Model of Change.
Each subject is assessed and identified
as being in a specific stage of
behavior change, and provided
interventions designed for that
stage. The interventions are provided
by study peers workers, social
workers, and support groups. The
program evaluation involves two
components: a self-administered
touch-screen adherence questionnaire
with an audio component; and,
a qualitative assessment of the
peer-client interaction. The study
comparea two data collection methods,
a face-to-face interview and the
touch-screen computer interview.
Description:
The Harlem Adherence to Treatment
Study: Evaluation of a Touch-Screen
Computer Adherence Questionnaire
and a Qualitative Assessment of
the Peer-Client Relationship.
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New
York Health Department (AIDS Institute)
Bruce D. Agins, M.D. , M.P.H.
1 University Place
Renssalaer, NY 12144-3456
(212) 613-2428
Project
Period: 10/99 - 9/02
Target
Population: A wide range of
people at the various sites
Description:
The Institute has funded ten comprehensive
adherence support programs throughout
New York State. The programs all
aim to increase adherence through
the following measures: development
of partnerships among clinical
and non-clinical providers and
clients; development of collaborative
management and operational structures;
empowerment of clients to make
informed treatment decisions;
integration of treatment into
the continuum of care; enhancement
of client skills; provide access
to support services tailored to
clients’ needs. Data are already
being gathered from the sites
for evaluation, and for the purposes
of the SPNS initiative, these
data are now being statistically
manipulated and combined with
the data from the other SPNS sites
for the national cross-site evaluation.
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Johns
Hopkins University, School of
Medicine
Richard D. Moore, M.D.
1830 East Monument Street, 4th
Floor
Baltimore, MD 21287
(410) 955-2144
rdmoore@jhmi.edu
Project
Period: 10/99 – 9/02
Target
Population: People with HIV
who have poor medical adherence,
active substance
use problems and mental illness,
high rates of unstable housing
and poverty,
and low educational level.
Description:
Project LINK is an intervention
program to increase adherence
with HAART at the Moore Clinic,
the Johns Hopkins Hospital HIV
specialty clinic. This program
specifically targets patients
who are HAART candidates but are
not prescribed or are failing
HAART therapy. The intervention
has four components: intensive
case management, one-on-one nursing
education, peer advocate support,
and group education/support sessions.
Clients are assigned to receive
two, three, or four of the intervention
components, with all clients receiving
case management and nurse education.
Adherence of the clients receiving
different combinations of interventions
will be compared with each other
as well as with a separate comparison
group.
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Mission
Neighborhood Health Center
Ricardo Alvarez, MD
240 Shotwell Street
San
Francisco, CA 94110
415-552-1013
Project
Period: 10/99 – 9/02
Target
Population: People with HIV
who are predominantly Hispanic,
many of whom
speak no English and experience
multiple psychosocial barriers.
Description:
Clinica Esperanza is an HIV clinic
with an interdisciplinary team
that provides medical and psychosocial
services, health and nutrition
education, treatment advocacy,
peer support, and complementary
therapies to its clients. The
Clinic has developed an adherence
intervention, the Medication Adherence
Protocol, or MAP, which: emphasizes
the client’s readiness to take
HAART by having multiple discipline
assessments; integrates cultural
competency, social support and
patients’ belief systems; and
builds in a system of checks and
balances. Clients are prepared
to begin taking HAART through
a series of meetings with the
medical provider, case manager/social
worker, and nurse or treatment
advocate. When they are determined
to be ready, they fill their prescriptions
and return to the clinic for an
assessment of their understanding
of the medicines and how to take
them, as well as for assistance
with putting the medications in
a multi-chambered container with
dividers for times of day and
days of the week (a medi-set).
Ongoing appointments with medical
providers, case managers and peers
provide continued adherence support
for clients.
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Multnomah
County Health Department
John Dougherty, MD, PhD
426 SW Stark Street
Portland,
OR 97204
(503) 248-3674
Project
Period: 10/99 – 9/02
Target
Population: People with HIV
who have problems with substance
use, mental illness, or homelessness.
Description:
The Multnomah County Health
Department HIV/AIDS Health Services
Center developed the Multidisciplinary
HAART Adherence Assistance Program
in June of 1998 to increase client
acceptance of and adherence to
HAART. The cornerstone of the
program is its multidisciplinary
approach. A clinical pharmacist,
health care professionals, and
social workers jointly address
the adherence needs of HAART clients.
The pharmacist coordinates the
program and serves as an integral
part of the care of HIV clients.
The pharmacy intervention is a
series of educational interventions
in which the pharmacist provides
education, counseling, and adherence
tools such as multi-sectioned
plastic boxes, or Medisets, for
storing a week’s supply of medicine.
The program works to improve client
readiness for antiretroviral treatment
prior to prescription, and support
client adherence to antiretroviral
treatment after prescription.
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North
Broward Hospital District
Kathleen Graham
303 SE 17th Street,
Suite 100
Ft. Lauderdale, FL 33316
954-355-4952
Project
Period: 10/99 – 9/02
Target
Population: People with HIV,
including women and African American
and
Hispanic people.
Description:
North Broward Hospital District
is implementing three outpatient
interventions of increasing intensity
to improve medication adherence:
Standard, Provider Enhanced Intervention
(PEI), and Home-based. The standard
intervention is comprised of the
interventions everyone attending
the clinic receive, including
a psychosocial assessment by a
case management and a clinicalassessment
by a health care provider. The
PEI is comprised of the standard
intervention plus two or three
sessions with the pharmacist,
who provides counseling, reminder
tools, and training videos. The
Home-based intervention is comprised
of all the previous components
plus two or three home visits
by a pharmacist or nurse, medicines
delivered to the home, and training
of the client’s caregivers to
help with adherence.
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Columbia
University SPH
Nancy VanDevanter, DrPH
600 West 168th Street
New York, NY 10032
(212) 305-1166
Project
Period: 10/99 - 9/02
Target
Population: HIV-infected women,
including adolescents, and caregivers
of HIV-infected children.
Description:
The Northern Manhattan Women and
Children HIV Project (NMWCHP)
is conducting the Northern Manhattan
Adherence Initiative. The initiative
is based upon the framework of
the Transtheoretical Model of
Stages of Behavior Change. The
goals of the program are to: 1)
integrate adherence boosting services
into the comprehensive medical
care and social support services
being provided to HIV-infected
women, adolescents, and caregivers
of HIV-infected children; 2) provide
appropriate information and support
to clients according to their
stage of readiness for taking/administering
these medications; and 3) improve
adherence among clients already
on antiretroviral therapy.
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University
of California, San Francisco
Alex Karal, PhD and Don Ciccorone,
MD
Urban
Helath Study
Dept.
of Family and Community Medicine
PO
Box 1304
San
Francisco, CA 94143
Project
Period: 10/99 – 9/02
Target
Population: Homeless or marginally
homeless HIV (+) individuals
Description:
For the urban poor, successful
adherence is especially challenging
given the high prevalence of drug
addiction and mental illness,
the inconsistency of adequate
food, and the instability of shelter.
The city of San Francisco established
the Action Point Adherence Project
(APAP) to assist individuals living
with poverty and HIV disease with
adherence to HIV therapy. Major
goals of the APAP are 1) To improve
the health status and quality
of life of HIV+ homeless or marginally
housed individuals currently on
antiretroviral treatment by enrolling
50 into the APAP and helping them
develop the skills to adhere to
their medication regimens with
the aim of helping them become
able to take their medications
independently, and 2) achieve
the same goals for HIV+ homeless
or marginally housed individuals
not on antiretroviral medications,
but who are planning to start
antiretroviral treatment by enrolling
50 into the APAP and stabilizing
them so they may successfully
initiate and adhere to antiretrovrial
regimens.
The
goals of the APAP evaluation are
to determine whether the program
can serve as a model for the delivery
of adherence support to this population
and to assist policy makers in
deciding whether similar projects
should be implemented in other
metropolitan areas.
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Washington
University School of Medicine
Linda Mundy, MD
Campus Box 8051
660 S. Euclid Ave.
St. Louis, MO 63110
314-747-1026
Project
Period: 10/99 – 9/02
Target
Population: Adolescent and
adult women with HIV, many of
whom are African American.
Description:
The Helena Hatch Special Care
Center (HHSCC) offers one-stop
comprehensive HIV services, including
primary HIV medical care, OB/GYN
services, social work and nursing
case management, patient education,
and psychosocial and spiritual
support. The Take Charge ADHERE
Program is the Center’s structured
adherence program. The adherence
program consists of the following
components: Assessment of patients’
readiness for taking HAART; Selection
of the best Drug regimen for each
patient; Development of tailored
Helping strategies; Evaluation
of adherence and regimen effectiveness
based upon current treatment guidelines;
Reinforcement or Readjustment
of treatment or adherence strategies;
and, Development of Endurance
strategies.
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