Vancouver, British Columbia, Canada

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Vancouver, British Columbia, Canada
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Clinical Outcomes and Quality of Life a
preliminary look at HIV participants enrolled in
a DOT Program

• Eirikka Brandson MSc PPH
• K.A. Fernandes, M.W. Tyndall, A.K. Palmer, K.C.
  Duncan, D. Tzemis, V.D. Lima, J.S.G. Montaner,
  R.S. Hogg
• Drug Treatment Program
• BC Centre for Excellence in HIV/AIDS, Canada
• XVII International AIDS Conference 3-8 August
  2008 Mexico City

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Background
Directly Observed Therapy (DOT) improves
adherence Optimizes adherence among vulnerable
groups Treatment requires high rates of
adherence
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Predictors of Optimal Adherence

• The Adherent patient
• Has emotional practical life supports
• Fits drug regimen into daily routine
• Understands non-adherence leads to resistance
• Recognizes that ALL doses must be taken
• Feels comfortable taking meds in front of others
• Keeps clinical appointments

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Predictors of Optimal Adherence

• Barriers to Optimal Adherence
• Drug dependency
• Mental illness
• Misinformation about ART
• Poor access to medical care
• Lack of patient education
• Criminal enforcement
• Hep C and other co-infections
• Unstable housing

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Objectives
1.) To evaluate the socio-demographic
characteristics, quality of life, and clinical
outcomes among persons enrolled in a Directly
Observed Therapy (DOT) program. 2.) To examine
whether there is an association between Viral
Load Suppression and being in the DOT program,
while accounting for potential confounders.
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Methods

• Longitudinal Investigations into Supportive and
  Ancillary health services (LISA) cohort is a
  prospective study of HIV persons on ART
• Participants recruited from the Drug Treatment
  Program at the BC Centre for Excellence
  in HIV/AIDS
• Interview administered survey that collects
  information
• Bivariable analyses Fishers Exact Test for
  categorial variables, Wilcoxon Rank Sum Test for
  continuous explanatory variables
• Multivariable confounder model used to
  investigate the association between Viral Load
  Suppression and being in the DOT program,
• adjusting for potential confounders

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Results
LISA Cohort (n481)
Other Participants DOT Participants (n417)
(n64) 101 (25) Female 18 (28)
Female 137 (33) Aboriginal 23 (36)
Aboriginal 46 Median Age 46 Median Age
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Social Factors
Results (2)
DOT less likely to be currently employed
DOT more likely to receive provincial income
assistance
DOT more likely to have unstable housing
DOT more likely to be food insecure
DOT more likely ever incarcerated
DOT more likely incarcerated last 6 months
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Results (3)
DOT less HIV Mastery
DOT less Provider Trust
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Drug Use
Results (4)
DOT less likely to have heavy alcohol use
DOT more likely to currently use drugs
DOT more likely to use methadone
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Clinical Variables
Results (5)
DOT more likely co-infected with Hepatitis C
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Results (6)
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Results (6)
No evidence of association between DOT program
and Viral Load Suppression
Viral Load Suppression associated with number of
years on therapy and CD4
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Conclusion
Preliminary findings demonstrate the success of
this program, as DOT participants showed similar
clinical outcomes when compared to their peers in
the cohort.
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Recommendations
The Adherent patient Has emotional practical
life supports Fits drug regimen into daily
routine Understands non-adherence leads to
resistance Recognizes that ALL doses must be
taken Feels comfortable taking drugs in front of
others Keeps clinical appointments
The Adherent patient Has emotional practical
life supports Fits drug regimen into daily
routine Understands non-adherence leads to
resistance Recognizes that ALL doses must be
taken Feels comfortable taking drugs in front of
others Keeps clinical appointments
Barriers to ART Adherence Drug dependency Mental
illness Misinformation about ART Poor access to
medical care Lack of patient education Criminal
enforcement Hep C and other co-infections Unstable
housing
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Recommendations
1.) Programs that help enable high adherence can
successfully result in healthy clinical
outcomes, but are not a long term
solution. 2.) The self-adherent patient can only
exist when the social factors and other root
cause barriers are addressed. 3.) Supportive
services are fundamental to the success of any
adherence intervention.
The Adherent patient Has emotional practical
life supports Fits drug regimen into daily
routine Understands non-adherence leads to
resistance Recognizes that ALL doses must be
taken Feels comfortable taking drugs in front of
others Keeps clinical appointments
The Adherent patient Has emotional practical
life supports Fits drug regimen into daily
routine Understands non-adherence leads to
resistance Recognizes that ALL doses must be
taken Feels comfortable taking drugs in front of
others Keeps clinical appointments
Barriers to ARV Adherence Drug dependency Mental
illness Misinformation about ARV therapy Poor
access to medical care Lack of patient
education Criminal enforcement Hep C and other
co-infections Unstable housing
Barriers to ART Adherence Drug dependency Mental
illness Misinformation about ART Poor access to
medical care Lack of patient education Criminal
enforcement Hep C and other co-infections Unstable
housing
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Thank you

• LISA participants
• Canadian Institute of Health Research
• BC CFE staff and statisticians
• Interview sites physicians

For more information ebrandson_at_cfenet.ubc.ca