School of Nursing Appointment Keeping Medication Adherence and

Background • Effective HIV disease management requires patients to: o o schedule & keep

Purpose To examine the relationship between appointment keeping and adherence to antiretroviral medications in

Study Overview Enrollment Baseline Month 1 Treatment (Intervention) Months 2 -13 Baseline and Random

Methods Baseline data were used Measures included: 1. Medical record review (# of missed

Sample Characteristics • The sample included 265 subjects • Missed appointments during the 6

Sample Characteristics Sixth International Conference on HIV Treatment and Prevention Adherence May 2011

Results— Characteristics Sixth International Conference on HIV Treatment and Prevention Adherence Any missed appointments?

Results—Adherence Self-Reported Adherence t = 3. 95, p <. 001 Any missed appointments? no

Results—Clinical Outcomes Any missed appointments? no yes t = 2. 02, p =. 045

Results—Clinical Outcomes Any missed appointments? no yes OR = 1. 72, p =. 036;

Limitations • CD-4 t-cell counts and viral load were not collected expressly for the

Conclusions • Appointment keeping is associated with o o medication adherence improved patient outcomes

Implications • Regular clinic visits offer opportunities for health providers to monitor and reinforce

Future Directions • The association between medication adherence and missed appointments needs to be

Acknowledgements • We would like to thank the research team and staff, the staff

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School of Nursing Appointment Keeping, Medication Adherence, and Clinical Outcomes in Patients with HIV Judith Erlen, Ph. D, RN, FAAN Susan M. Sereika, Ph. D Hyngjoo Kang, MS Lisa K. Tamres, MS Funded by NINR: R 01 NR 04749

Background • Effective HIV disease management requires patients to: o o schedule & keep clinic appointments follow their prescribed medication regimen o o targets to potentially improve clinical outcomes additional assessments of patient adherence • These requirements can serve as: • There is limited literature addressing medication adherence and clinic appointments Sixth International Conference on HIV Treatment and Prevention Adherence May 2011

Purpose To examine the relationship between appointment keeping and adherence to antiretroviral medications in a sample of patients with HIV/AIDS participating in a randomized control trial designed to improve medication adherence Sixth International Conference on HIV Treatment and Prevention Adherence May 2011

Study Overview Enrollment Baseline Month 1 Treatment (Intervention) Months 2 -13 Baseline and Random Assignment Usual Care n = 92 Follow-up Months 14 -19 Sixth International Conference on HIV Treatment and Prevention Adherence Individualized Intervention n= 84 Structured Intervention n = 78 Post Follow-up May 2011

Methods Baseline data were used Measures included: 1. Medical record review (# of missed visits) 2. Electronic event monitors 1. Dose Adherence: percent of correct doses of ARV medication taken over a two week period 2. Days Adherence: percent of days with correct intake over a two week period 3. Self-report of adherence (Morisky) 4. Demographic questionnaire Sixth International Conference on HIV Treatment and Prevention Adherence May 2011

Sample Characteristics • The sample included 265 subjects • Missed appointments during the 6 months prior to baseline data collection were recorded Sixth International Conference on HIV Treatment and Prevention Adherence May 2011

Sample Characteristics Sixth International Conference on HIV Treatment and Prevention Adherence May 2011

Results— Characteristics Sixth International Conference on HIV Treatment and Prevention Adherence Any missed appointments? no yes May 2011

Results—Adherence Self-Reported Adherence t = 3. 95, p <. 001 Any missed appointments? no yes EEM Adherence t = 3. 41, p =. 001 Sixth International Conference on HIV Treatment and Prevention Adherence t = 3. 57, p <. 001 May 2011

Results—Clinical Outcomes Any missed appointments? no yes t = 2. 02, p =. 045 Sixth International Conference on HIV Treatment and Prevention Adherence May 2011

Results—Clinical Outcomes Any missed appointments? no yes OR = 1. 72, p =. 036; 95% CI = [1. 04, 2. 85] Sixth International Conference on HIV Treatment and Prevention Adherence May 2011

Limitations • CD-4 t-cell counts and viral load were not collected expressly for the study. • Missed appointments may have been underestimated in the medical records. Sixth International Conference on HIV Treatment and Prevention Adherence May 2011

Conclusions • Appointment keeping is associated with o o medication adherence improved patient outcomes Sixth International Conference on HIV Treatment and Prevention Adherence May 2011

Implications • Regular clinic visits offer opportunities for health providers to monitor and reinforce the importance of medication adherence to decrease HIV disease progression. Sixth International Conference on HIV Treatment and Prevention Adherence May 2011

Future Directions • The association between medication adherence and missed appointments needs to be examined over time. Sixth International Conference on HIV Treatment and Prevention Adherence May 2011

Acknowledgements • We would like to thank the research team and staff, the staff at the Western Pennsylvania and Ohio HIV clinics, and most especially our study participants for their help in this research. • This study was funded by the National Institute for Nursing Research ([NINR] R 01 NR 04749). Sixth International Conference on HIV Treatment and Prevention Adherence May 2011