[ARCHIVED] Adherence & Retention

Guidelines for Improving Entry Into and Retention in Care and Antiretroviral Adherence for Persons With HIV: Evidence-Based Recommendations From an International Association of Physicians in AIDS Care Panel

Started by K. Rivet Amico, PhD on 05 Mar 2012

A new resource has become available- noted below-- that would be great to add to our community discussions. Below is a link to newly published/available guidelines for HIV care entry and retention and ART adherence monitoring and support. It is really exciting to see these recommendations come together after a long journy of intensive culling of the literature and synthesizing outcomes for general and specific populations.

I was wondering... what are people's impressions? How immediately useful are the guidelines? Can they inform practice and future research?

I am eager to hear what the community thinks!!

Warm regards,
Rivet Amico



Guidelines for Improving Entry Into and Retention in Care and Antiretroviral Adherence for Persons With HIV: Evidence-Based Recommendations From an International Association of Physicians in AIDS Care Panel

Melanie A. Thompson, Michael J. Mugavero,. Rivet Amico, Victoria A. Cargill, Larry W. Chang, Robert Gross, Catherine Orrell, Frederick L. Altice, David R. Bangsberg, John G. Bartlett, Curt G. Beckwith, Nadia Dowshen, M. Gordon, Tim Horn, Princy Kumar, James D. Scott, Michael J. Stirratt, H. Remien, Jane M. Simoni, and Jean B. Nachega

Ann Intern Med., 1st published ahead of print March 5, 2012,

Free HTML full text http://www.annals.org/content/early/2012/03/05/0003-4819-156-11-201206050-004...

Abstract
Description: After HIV diagnosis, timely entry into HIV medical care and retention in that care are essential to the provision of effective antiretroviral therapy (ART). ART adherence is among the key determinants of successful HIV treatment outcome and is essential to minimize the emergence of drug resistance. The International Association of Physicians in AIDS Care convened a panel to develop evidence-based recommendations to optimize entry into and retention in care and ART adherence for people with HIV.

Methods: A systematic literature search was conducted to produce an evidence base restricted to randomized, controlled trials and observational studies with comparators that had at least 1 measured biological or behavioral end point. A total of 325 studies met the criteria. Two reviewers independently extracted and coded data from each study using a standardized data extraction form. Panel members drafted recommendations based on the body of evidence for each method or intervention and then graded the overall quality of the body of evidence and the strength for each recommendation.

Recommendations: Recommendations are provided for monitoring of entry into and retention in care, interventions to improve entry and retention, and monitoring of and interventions to improve ART adherence. Recommendations cover ART strategies, adherence tools, education and counseling, and health system and service delivery interventions. In addition, they cover specific issues pertaining to pregnant women, incarcerated individuals, homeless and marginally housed individuals, and children and adolescents, as well as substance use and mental health disorders. Recommendations for future research in all areas are also provided.
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MEDIA Review re the above: IAPAC Guidelines Offer Recommendations to Optimize Entry into and Retention in HIV Care, and HIV Treatment Adherence
 
Guidelines e-Published Today by Annals of Internal Medicine

Washington, DC (Monday, March 5, 2012) - The International Association of Physicians in AIDS Care (IAPAC) today announced the publication of a new set of evidence-based guidelines meant to optimize entry into and retention in HIV care and adherence to HIV treatment. The "Guidelines for Improving Entry into and Retention in Care and Antiretroviral Adherence for Persons with HIV" were developed by an expert IAPAC Panel and e-published today by the Annals of Internal Medicine.

The guidelines include recommendations in several key areas, including: entry into and retention in care; monitoring adherence to HIV care and antiretroviral therapy (ART); interventions to improve ART adherence including those involving choice of ART regimens; adherence tools for patients; education and counseling; and health system and service delivery interventions. The needs of special populations (such as pregnant women, individuals with mental health and substance use disorders, homeless and marginally housed individuals, incarcerated individuals, and children and adolescents) are also addressed in the guidelines, as are recommendations for future research in these areas.
 
"Over the last 15 years, we have made astounding progress in HIV treatment, resulting in longer and healthier lives for people living with HIV. Yet many people are unable to optimally benefit from these advances because of delayed diagnosis and multiple challenges to entering and staying in medical care," said Melanie A. Thompson, MD, co-chair of the IAPAC Panel. "Once receiving potent treatment for HIV, many struggle to take their drugs consistently. Unfortunately, missed doses and drug holidays lead to resistant virus and, often, to treatment failure. Ultimately, both individual and public health depend on helping patients to successfully negotiate all of the steps of this treatment cascade."
 
According to the US Centers for Disease Control and Prevention (CDC), only 69% of HIV-positive persons in the United States enter HIV care, 59% are retained in care, and only 28% of Americans living with HIV have an undetectable viral load.1 A recent African study found that more than two-thirds of HIV-positive individuals were lost from care if they were not yet eligible for drug treatment.2

In addition, a review of 84 observational studies - or 33,199 adults on ART - revealed that only 62% achieved adherence of at least 90% of prescribed ART doses.3 Adherence to ART has been shown to be an important predictor of achieving adequate suppression of HIV replication, which is required to minimize resistance to HIV treatments, slow disease progression, delay AIDS-related death, and decrease the transmission of HIV to others.

"These guidelines are the foundation of an evolving blueprint that practitioners and health systems can use as a resource to improve entry into and retention in HIV care as well as adherence to HIV treatments," said Thompson, who is also Principal Investigator of the AIDS Research Consortium of Atlanta. The Panel co-chair is Jean B. Nachega, MD, PhD, of Johns Hopkins University/Stellenbosch University, Baltimore, MD, USA, and Cape Town, South Africa, respectively.

"IAPAC is proud of the work advanced by our Panel in developing these pioneering guidelines, which we hope will help strengthen the three pillars of HIV treatment success - entry into and retention in care, as well as ART adherence," said Jose M. Zuniga, PhD, MPH, IAPAC's President. "We have known for some time that much more attention is required to optimize the way in which HIV-positive patients are linked to and retained on HIV treatment so that they derive the full benefit of existing care, treatment, and support. These guidelines are an important step in that direction."
 
Zuniga further identified some immediate steps IAPAC is taking to implement the guidelines' recommendations. In the next several months, IAPAC will launch a multidisciplinary continuing education-accredited online activity to educate physicians, nurses, pharmacists, and psychologists about the guidelines' recommendations. Peer educator and patient-oriented activities to increase health and HIV literacy, and to facilitate guidelines-recommended behavioral interventions are also planned.

Guidelines development was jointly sponsored by IAPAC and the US National Institutes of Health's Office of AIDS Research.

The e-published guidelines are available at www.annals.org. A date for print publication of the guidelines in the Annals of Internal Medicine is pending.

Centers for Disease Control and Prevention. Vital signs: HIV prevention through care and treatment - United States. MMWR. 2011;60:1618-1623.
Rosen S, Fox MP. Retention in HIV care between testing and treatment in sub-Saharan Africa: A systematic review. PLoS Medicine. 2011;8(7):e1001056.
Ortego C, Huedo-Medina TB, Llorca J, et al. Adherence to highly active antiretroviral therapy (HAART): A meta-analysis. AIDS Behav. 2011;15(7):1381-1396.

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The International Association of Physicians in AIDS Care (IAPAC) is a non-profit medical association representing more than 17,000 clinician-members in over 100 countries. Its mission is to improve the quality of care, treatment, and support provided to people living with HIV/AIDS, hepatitis, malaria, and tuberculosis through education, research, global health, and advocacy activities advanced by its clinician-members. Visit www.iapac.org for more information about IAPAC.Connect with your readers - why do they engage with you, why do they support your mission?

Keywords: Clinical Guidelines  Monitoring & Measurement  Patient Education