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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: [email protected]
INTRODUCTION• Poor adherence to antiretroviral therapy (ART) is a major
obstacle to successful treatment outcomes 1,2
• There is evidence that telephone support improves adherence in several medical areas 3
• In developing countries mobile phones are widely used 4
• The registry of medication dispensed is an indirect method to assess adherence with acceptable sensitivity and specificity 5
1. Wood E et al, J Acquir Immune Defic Syndr 2004; 35(3):261-268.2. Garcia de Olalla P et al, J Acquir Immune Defic Syndr 2002; 30(1):105-110.3. Lester RT et al, The Lancet 2010; 376 (9755):1838-1845.4. The real digital divide. The Economist 10 March 2005.5. Pérez-Simón MR et al, Med Clin (Barc) 2003; 120 (18):701-3.
OBJECTIVE
To evaluate the efficacy of an adherence strategy based on a computer alarm system
and telephone support intervention
METHODS (I)Setting: A private specialized medical center in Buenos Aires City and affiliates in the provinces.
Design: •Retrospective comparative intervention cohort study.•The comparator referred to was the year 2006. •In 2007 a newly installed computer alert system began toidentify any delay in ART dispensing. •Adherence strategies of telephone support were applied.• Data from 2007, 2008 and 2009 were compared against 2006. •The rates of dispensed ART were compared as indirect indicators of adherence.
METHODS (II)
Intervention: Adherence strategies for telephone support
Psychologists, social workers and persons living with HIV were trained in:
1. HIV/AIDS counseling2. Communication skills 3. Computer skills4. Team work skills5. Confidentiality policy
Outcome Measure: Yearly rate of pharmacy dispensing with respect to the
baseline
METHODS (III): Study Population
TABLE 1. Medical Monitoring Population: 2006 to 2009
2006a 2007b 2008 2009
N° of Patients 3,319 3,430 4,040 4,584
Age, mean years 37.0 (SD11.5) 37.3 (SD11.3) 37.7 (SD11.2) 38.4 (SD11.4)
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 comparatorb Year 2007: Start of the warning computer system and telephone support adherence to ART
FLOW CHART OF THE INTERVENTION
TABLE 2. HAART pick-up rates, rates of VL studies <50 copies / mL, and median CD4 cell count
Year 2006a 2007b 2008 2009
HAART pick up, %
(95% CI)
78.1
(77.58 - 78.59)
81.4
(80.97 - 81.888)
81.0
(80.52 - 81.37)
83.2
(82.85 - 83.60)
VL <50 copies / mL,%,
(95% CI)
53.7
(52.25 - 54.99)
59.6
(58.24 - 60.88)
62.7
(61.52 - 63.95)
69.3
(68.17 70.36)
CD4 cells / mL, median
(IQR)
436
(292-615)
422
(285-593)
447
(306-616)
476
(327-651)
a Year 2006: Baseline comparatorb Year 2007: Start of the warning computer system and telephone support
RESULTS (I)
RESULTS (II) Figure 1. HAART pick-up rates of pharmacy vs. Baseline (2006)
Figure 2. Percentage of studies with VL <50 copies / mL
RESULTS (III)
POLICY IMPLICATION & CONCLUSION
• Our findings show that centralized data of pharmacy dispensing, with a computer alarm system for any delay and telephone support improves long-term adherence to ART and clinical outcomes.
• Mobile telephones are widespread, even in the poorest countries in the world. This gives health care givers the opportunity to communicate with patients and thus strengthen adherence to treatment.
• Health policies that centralize computerized data and encourage the training of staff may promote the replication of these interventions tailored to other different settings.
• This experience requires the work of members of different areas, which involves the development of teamwork skills. Supervision, coordination and training of people in charge are necessary in order to prevent this intervention from becoming a purely administrative and inefficient task.
