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© 2007 Baylor College of Medicine Impact of In-Reach Program On Adherence in Botswana Selolwane, G., Machine, E., Adegbite M, Selolwane, G., Machine, E.,

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Presentation on theme: "© 2007 Baylor College of Medicine Impact of In-Reach Program On Adherence in Botswana Selolwane, G., Machine, E., Adegbite M, Selolwane, G., Machine, E.,"— Presentation transcript:

1 © 2007 Baylor College of Medicine Impact of In-Reach Program On Adherence in Botswana Selolwane, G., Machine, E., Adegbite M, Selolwane, G., Machine, E., Adegbite M, Karugaba G., Mullan, P., Phelps R; Anabwani, G.; BIPAI Network Meeting 2008

2 © 2007 Baylor College of Medicine Objectives of this presentation To outline the Botswana In- Reach Program To show ARV adherence trends among In-Reach patients Make inference on the impact of the program Identify ways of strengthening/ improving the In-Reach program

3 © 2007 Baylor College of Medicine In-Reach Program defined Program whereby children already enrolled at the COE clinic are visited at their homes Refers to home based community support for HIV+ children Based on experience, assumes that patients failing treatment are largely as a result of psychosocial problems rooted in the home environment A failing patient would be better managed by carrying out home visits to better understand the home environment

4 © 2007 Baylor College of Medicine In-Reach Program defined Adherence of between 95% and 105% is highly recommended for ARVs to avoid resistance and toxicity respectively BBCCCOE has identified children with inadequate adherence and other risk variables (caregiver instability, food insecurity, etc) These selected children and their caregivers receive additional adherence counseling and attend additional didactic teaching sessions. Failure in these measures leads to referral for In- Reach

5 © 2007 Baylor College of Medicine Methods Retrospective study Data was extracted from patients who have been followed up through the In- Reach program For each patient we tracked objective adherence % at baseline and thereafter

6 © 2007 Baylor College of Medicine Methods There were 98 patients with adherence problems who qualified and who were referred for in reach follow up. We report on 29 patients with complete records.

7 © 2007 Baylor College of Medicine CM Number Adherence % at baseline Adherence FU01 Adherence FU02 Adherence FU03 Adherence FU04 Adherence FU05 5465686%97%99%100% 6137988%not possible96% 6294578%100%97%100% 5722793%95% 98% 5522050%100% 62282108% 100%97% 5670077%100% 6495887%90%100% 5578297%100% 99%100% 56364100% 88%100%86%100% 5822875%99% 102%99%100% 6344190%OFF92%100%OFF96% 54415 86%100%98% 97% 5770094%86%93%100% 98% 5563376%99%100%102%100% 5661580% not pos.99%88% 5472593%100% 61832 88%100% 98% 62664 100% 90%104% 5586590%100% 5491787%98% 100% 5537075% 95% 55578 59%97%100% Meds OS100% 8009485%81%OFFnot poss.94%100% 56294 POOR101%100%101%100% 5556481%98% 5653584%141%102%100% 5649964%114%105%100% 7794984%96%100% Mean

8 © 2007 Baylor College of Medicine Example Patient CM NumberAdherence % at baseline Adherence FU01 Adherence FU02 Adherence FU03 Adherence FU04 Adherence FU05 5822875%99% 102%99%100%

9 © 2007 Baylor College of Medicine Findings

10 Findings

11 Findings

12 Findings

13 Observations

14 Observations After the home visits have been initiated, we observed that adherence levels improved. Through home visits, we discover strengths as well as weaknesses and intervene accordingly. From the results above, the trends serve to show that the In-reach program has a positive impact on adherence

15 © 2007 Baylor College of Medicine Lessons learnt The home visits can be scaled up to include other aspects beyond adherence We did not separate our results between medicine formulation. It will be more informative to observe adherence trends in pills and liquid medications separately It would also have been useful to have the adherence trends before the intervention of home visits for comparison

16 © 2007 Baylor College of Medicine Management team at the BBCCCOE Edwin Machine Grace Karugaba Nkumbuludzi Ndwapi

17 © 2007 Baylor College of Medicine


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