An Adherence-Focused Case Management Intervention for HIV-Positive Patients in a Public Care Setting

Abstract

An adherence-focused case management intervention was evaluated in 84 public clinic patients in Los Angeles County, California, and included weekly contact with a paraprofessional case manager development of an individualized highly-active antiretroviral therapy (HAART) adherence support plan, and referrals to ancillary services. Participants were primarily Latino (65%) or African American (25%); male (74%); monolingual Spanish-speakers (57%) with annual incomes under $10,000 (65%). Participants were in the intervention for a median of 26 weeks; attended 67% of appointments; participated in an average of 9 hours of case management; and each visit averaged 23 minutes. Seventy-two percent of the goals established at baseline were achieved and 74% of referrals were completed. The most common goals were related to adherence (16%), housing (12%), or nutrition (12%). Self-reported adherence to HAART was no different for intervention participants compared to those in standard case management at 6 months. These data suggest that an adherence-focused case management program was effective in achieving established goals and referrals. In addition, the existing provider and standard case management adherence support appears sufficient to sustain adherence in this public clinic population.

KEYWORDS:

• adherence
• case management
• HAART

Financial support for this study was provided by CDC Cooperative Agreement No. U64/CCU919440 and California HIV/AIDS Research Program grant CH05-LAC-617. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the CDC. The authors would like to acknowledge the study staff who delivered the project interventions, including Ana Ballesteros, Otilia Galindo, Benjamin Iniguez, Rolando Perez, Rosidey Monge, Miguel Fernandez, and Katharine Santos. In addition, we would like to acknowledge the following individuals in the Office of AIDS Programs and Policy at LADPH for their support and efforts on behalf of this project: Charles Henry, Elizabeth Boyce, Vicki Nagata, and Matthew Harwood.

Notes

^a Referent group is African Americans, whites, and others.

^b Referent group is Latinos, whites, and others.

^c Referent group is African Americans, Latinos, and others.

EE, early exit; LTF, lost to follow-up; MTF, male-to female; OR, odds ratio; CI, confidence interval; MSM, men who have sex with men; IDU, injection drug use; NIR, no identified risk; IQR, interquartile range; NS, not significant; IACM, intensive adherence-focused case management.

^a Data are missing for one participant who completed IACM.

IACM, intensive adherence-focused case management; NS, not significant; IQR, interquartile; SD, standard deviation.

^a Data are missing for one participant who completed IACM.

IACM, intensive adherence-focused case management; NS, not significant.

^a Data are missing for one participant. Values given as n (%).

^a Includes 110 patients who were taking HAART at enrollment into the study.

^b Includes a subset of 90 patients who could be contacted via telephone for a follow-up interview.

IACM, intensive adherence-focused case management; SOC, standard of care; HAART, highly active antiretroviral therapy.