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What Do We Know About Adherence in ICAP Programs?: A Review of the Data
- 1. ICAP Adherence Data Molly McNairy, MD, MSc Supporting Sustainable Adherence to HIV Prevention, Care & Treatment ICAP Technical Workshop October 19-22, 2009Kigali, Rwanda
- 3. Meta-Analysis: Adherence at 2 years Rosen et al. PLoS 2007 32 studies in SSA 1996-2007 ~75,000 patients in non-research ART 6 mo = 80% pts retained 12 mo = 60% pts retained At 2 Years*: BEST CASE = 84% WORST CASE = 46% AVERAGE = 61% ~40% LTFU at 2 years Of which, LTFU 56%, Death 40% 61% at 24 months
- 4. A closer look at ICAP Adherence Data June 2009 URS, PFaCTS, Patient-level “Those are other programs”
- 8. Two-year cumulative risk of death, loss to follow-up9, and loss to program8among ART patients since ART initiation (Total 91,612 patients)
- 9. Pediatric ART patients since ART Initiation Patient level data through June 2009 (n= 28 sites)
- 10. Applying the Meta-Analysis ResultsTo ICAP Adherence Data “Good Adherence>95%” Our GAP *Rosen et al PLoS Med 4 (10) 2007
- 11. Cumulative and current enrollment in ART care at ICAP-supported HIV care and treatment programsas of June 2009 (n= 327,092) Cumulative initiating ART Lost to follow up Reported dead Number of patients ART patients retained in care
- 12. Status of ART patients at ICAP sites June 2009 (n= 327,092) 10.3% per year on ART Lost to Follow-up 5.3% per year on ART Reported Dead .59% per year on ART Stopped ART *Includes patients who transferred out while on ART.
- 13. PFaCTS Data on Adherence services Type of patient support service Type of adherence service # outreach workers Methods for tracking missed appointments Time to follow-up/tracking
- 14. Sites offering on-site patient support services (n=323) Take Home: All sites have services, but what are those services doing? % sites with service
- 15. 64%
- 17. Mean number of outreach workers at ICAP-supported HIV care and treatment sites (n=183) Mean number of outreach workers
- 18. Number of outreach workers per 1,000 active ART patients at ICAP sites with at least 1 dedicated outreach worker,PFaCTS Round 4 (Jan-Jun 2009) n=8 n=48 n=18 n=11 n=17 n=39 n=8 n=33 n=207 n=24 n=1 Note: The bubbles represent the median across sites and the bars represent the IQR.
- 19. Prevention Services Offered at ICAP Sites % sites
- 22. Time between missed appointment and contact attempt for ART patients PFaCTSRound 4 (Jan-Jun 2009)
- 24. Lost to treatment program & treatment interruptions
- 25. Clinical records
- 26. Patient self-report, pill count, recall
- 30. Proportion of adult ART patients on second line regimens in ICAP supported care and treatment sites, June 2009 Note: Restricted to sites that report >=90% of regimen data
- 32. ICAP has LTFU rates similar to other large ARV programs
- 33. 40% ART pts LTFU at 2 years (worst case)
- 34. Yet, ICAP has >98% of sites reporting adherence programs and multi-level pt support services
- 35. > 75% sites report counseling more than 1 month, dedicated adherence pharmacist, and remember/education tools
- 36. >85% of sties report having appointment registers
- 37. > 70% sites report capacity for patient tracking with phone calls, home visits
- 38. Average of 6 outreach workers/1000 ART patientsHow can we strengthen our adherence support services?