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UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 1 The University of Illinois at Chicago Howard Brown Health.

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Presentation on theme: "UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 1 The University of Illinois at Chicago Howard Brown Health."— Presentation transcript:

1 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 1 The University of Illinois at Chicago Howard Brown Health Center Treatment Advocacy Program HIV medication skills 1: Basic skills and adherence planning

2 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 2 HIV Medication skills for men currently on HIV treatment Health & Well Being Coping with Sexuality & Treatment We will start with some basic information, then we will discuss coping with treatment. Welcome to treatment coping and medication skills.

3 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 3 Adherence Information: Basic treatment terms… What is… Adherence? -- taking all pills on time (+ / - 2 hours..) -- following food or other restrictions -- making your medical appointments What is… Viral Load? -- amount of virus in your blood -- # copies / ml. (about 1/2 table spoon) What are… T cells? -- an important white blood cell (CD4) -- strengthens your immune system What is… Resistance? -- mutations in HIV from low adherence -- makes the virus able to fight off drugs Click here for more HIV Information Click here for more HIV Information Click here for more HIV Information Click here for more HIV Information Let’s begin with some basic terms…

4 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 4 Adherence Information: Importance Over half of patients have a drug failure Median time to drug failure = 18 months Why is adherence important…? Non-adherence can make HIV resistant to medications. Increasing viral load Increasing viral load Lower CD4 count / fewer T-cells Lower CD4 count / fewer T-cells Medications no longer effective Medications no longer effective Resistance leads to “drug failure”:

5 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 5 Adherence Information: baserates Over a third of patients miss > 20% of doses Over a third of patients miss > 20% of doses At least half show some non-adherence At least half show some non-adherence At least a quarter take partial or late doses At least a quarter take partial or late doses Non-adherence is common in HIV …and in other chronic diseases Diabetes Diabetes Hypertension Hypertension Cardiac care… Cardiac care…

6 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 6 Non-Adherence: Who and Why? (1) Lack of Information Ask questions!! Ask questions!! Difficulty talking to your provider? Difficulty talking to your provider? What makes people not adhere? We will review communication skills a bit later Important to speak to your provider Important to speak to your provider Nutrition or other meds may help Nutrition or other meds may help Reaction to (often temporary) side effects

7 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 7 Non-Adherence: Who and Why? (2) Depression, anger, & other moods Depression, anger, & other moods Social support or conflict Social support or conflict Avoiding / not “out” about being HIV+ Avoiding / not “out” about being HIV+ Alcohol or drug use Alcohol or drug use Why non-adherence We will review these areas next session We will review these areas next session Referral or counseling for these issues now? Referral or counseling for these issues now? Moods & behaviors

8 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 8 Non-Adherence: Who and Why? (3) Where did I park last night? Where did I park last night? Repeating the same behavior makes it hard to remember each day Repeating the same behavior makes it hard to remember each day Yesterday’s “pill memory” interferes with remembering today’s… Yesterday’s “pill memory” interferes with remembering today’s… Basic human memory The memory full problem  Do not rely on personal memory  Use “outside” reminders or cues Why non-adherence

9 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 9 Non-Adherence: Who and Why? (4) Most day-to-day routines are “mindless” Most day-to-day routines are “mindless” Driving: How did I get here? Driving: How did I get here? It is hard to recall / do something new It is hard to recall / do something new Memory of your meds can be “swept away” by your automatic routine… Memory of your meds can be “swept away” by your automatic routine… Automatic behavior Use “outside” cues to… Interrupt automatic routine Interrupt automatic routine Be “mindful” Be “mindful” How does memory interfere with adherence…?

10 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 10 Adherence Information: non-automatics Keeping a medication schedule takes effort, skills and strategies. We will work on skills in this section. Thus … Treatment adherence is not automatic.

11 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 11 Continuing Safety: Super Infection You can be infected with a whole new strain of HIV  Makes your HIV drugs less effective  Makes your treatment very difficult Even though you are HIV+, sexual safety is still important: The new strain would be resistant to your current HIV drugs It may be resistant to other drugs

12 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 12 Adherence Information: Drug resistant strains Drug resistant HIV can be transmitted to others by unsafe sex Many new infections are resistant to an entire class of HIV drugs Many new infections are resistant to an entire class of HIV drugs Between 10% and 30% of new infections may be resistant to > 1 class of drugs Between 10% and 30% of new infections may be resistant to > 1 class of drugs Why is sexual safety still important?

13 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 13 Adherence Information: Sexual Risks, 1 Causes your viral load to “spike” even if it is “undetectable” Causes your viral load to “spike” even if it is “undetectable” STDs reactivate latently infected cells: STDs are more serious in HIV+ men STDs are more serious in HIV+ men … makes your HIV harder to control. … makes you more likely to infect others. … more difficult to treat if you are HIV+ Sexual Risk Reduction is also important for your HIV care…

14 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 14 New STDs: Bottom line … half of recent Chicago syphilis cases are HIV+ men A lot of infected men think they can’t get new STDs. A new STD can be very serious for you A new STD can be very serious for you You can get one from unprotected sex You can get one from unprotected sex BOTTOM LINE: In fact,

15 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 15 Information: new infections Unsafe sex and HIV infections Why might this be happening? are both increasing

16 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 16 Causes of new infections? “Barebacking” culture? “Barebacking” culture? General shift in gay / bi sexual norms? General shift in gay / bi sexual norms? How do these apply to you? How about: HIV treatments making some men less concerned about unprotected sex? HIV treatments making some men less concerned about unprotected sex?

17 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 17 Adherence Information: Safety + Adherence = Health Two basic HIV health formulas: Viral load Resistance T-cells Full Adherence = ++ Safer sex = Avoid STD infections Not pass on HIV + Avoid HIV “Super- infection” +

18 UIC / HBHC Treatment Advocacy Program Main Menu What is full adherence? TAP: Medication skills 1, basic skills 12/9/03 18 What is “Full” adherence to treatment?

19 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 19 Adherence Skills: Adherence & medication effectivenessAdherence 2 dose/day regimen Effectiveness of HIV meds [% patients with < 200 copies HIV / ml blood ] Full Adherence: Over 80% effective About 50% effective About 25% Less than 10% effective 95% adherence missed doses per month 90% adherence missed doses per month 80% adherence missed doses per week 70% adherence missed doses per week < 70% adherence 5 or more misses per week Bottom Line: 95% of doses 95% of doses On time (+/- 2 hours) On time (+/- 2 hours) Bottom Line: 95% of doses 95% of doses On time (+/- 2 hours) On time (+/- 2 hours) Adhering to your schedule directly affects how well medications work. About 65% effective

20 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 20 Adherence Skills: Timing of doses Taking your doses on time keeps your blood level in the optimal zone… Maximum Optimal Minimum 9:00 am 9:00 pm 9:00 am 9:00 pm Each dose on time (9am, 9pm, 9am…); blood level stays in the zone Late dose (9am, 12pm, 9am ; levels get too low, then too high Missed dose; levels get very low, slowly recover The timing of doses is also very important.

21 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 21 Med. status Let’s begin talking about how you are doing with your HIV medications right now

22 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 22 Medication Overview Sheet Pharmacy & provider contact info. phone #s, emergency #s Which pills at which times? Which pills at which times? Time schedule that works best for you? Time schedule that works best for you? Food or other restrictions? Food or other restrictions? What HIV medications do you take? How many doses each day? What side effects or other problems are you concerned about?

23 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 23 Adherence: Missed doses How many visits have you missed in the past year ? (where you did not make them up..) How often do you see your HIV Doctor or health care provider? (# months)

24 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 24 Non-HIV meds. How long have you taken them? How long have you taken them? How many doses each day? How many doses each day? How many doses have you missed in the past week? How many doses have you missed in the past week? What non-HIV medications do you take?

25 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 25 Adherence: Interruptions In the past 3 months… have you stopped any medication for a week or more? No Yes (click one)

26 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 26 Go back to skip meds item Advocate: please go back and click on one answer

27 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 27 Adherence: Medication interruptions How many times have you stopped your medications? How long have you stopped? Why did you decide to stop your med(s)? side effects adherence problems physical difficulty taking meds drug interruption with medical supervision drug interruption without medical supervision other: improved health cost / availability of meds

28 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 28 Coping Interview, Adherence: Overall rating How often have you missed an HIV dose in the past 3 months? Two doses a day: One dose a day: Never Less that once a month Once a month 2 or 3 times a month Once a week or so Twice a week or more Never Once a month or less Several times a month Once or twice a week Three or four times a week Five or more per week

29 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 29 Go back to adherence scale Advocate: please go back and click on one number from the scale

30 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/ % Adherence Adherence 2 dose/day regimen Effectiveness of HIV meds [% patients with < 200 copies HIV / ml blood ] Full Adherence: Over 80% effective 95% adherence missed doses per month About 65% effective About 50% effective About 25% Less than 10% effective 90% adherence missed doses per month 80% adherence missed doses per week 70% adherence missed doses per week < 70% adherence 5 or more misses / week You are doing very well You are doing very well Work on maintaining this level Work on maintaining this level Let’s compare your behavior to the adherence chart Bottom Line:

31 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/ % Adherence Adherence 2 dose/day regimen Effectiveness of HIV meds [% patients with < 200 copies HIV / ml blood ] 90% adherence missed doses per month Full Adherence: Over 80% effective About 50% effective About 25% Less than 10% effective 95% adherence missed doses per month 80% adherence missed doses per week 70% adherence missed doses per week < 70% adherence 5 or more misses / week O.K. / good adherence O.K. / good adherence We can get to the next level.. We can get to the next level.. Let’s compare your behavior to the adherence chart Bottom Line: About 65% effective

32 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/ % Adherence Adherence 2 dose/day regimen Effectiveness of HIV meds [% patients with < 200 copies HIV / ml blood ] About 50% effective 80% adherence missed doses per week Full Adherence: Over 80% effective About 65% effective About 25% Less than 10% effective 95% adherence missed doses per month 90% adherence missed doses per month 70% adherence missed doses per week < 70% adherence 5 or more misses / week Moderate adherence – some problems Moderate adherence – some problems We need to work on getting to the next level We need to work on getting to the next level Let’s compare your behavior to the adherence chart Bottom Line:

33 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 33 About 25% effective 70% Adherence Adherence 2 dose/day regimen Effectiveness of HIV meds [% patients with < 200 copies HIV / ml blood ] 70% adherence missed doses per week Full Adherence: Over 80% effective About 65% effective About 50% effective Less than 10% effective 95% adherence missed doses per month 90% adherence missed doses per month 80% adherence missed doses per week < 70% adherence 5 or more misses / week Adherence problems Adherence problems Medications may not be effective at this adherence Medications may not be effective at this adherence Let’s compare your behavior to the adherence chart Bottom Line:

34 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 34 < 70% Adherence Adherence 2 dose/day regimen Effectiveness of HIV meds [% patients with < 200 copies HIV / ml blood ] Less than 10% effective Full Adherence: Over 80% effective About 65% effective About 50% effective About 25% 95% adherence missed doses per month 90% adherence missed doses per month 80% adherence missed doses per week 70% adherence missed doses per week < 70% adherence 5 or more misses / week Adherence problems Adherence problems Medications will not be effective at this adherence Medications will not be effective at this adherence If we cannot improve adherence consider stopping meds. If we cannot improve adherence consider stopping meds. Let’s compare your behavior to the adherence chart Bottom Line:

35 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 35 Adherence skills Now let’s review some skills that can help improve or maintain adherence. After this we will discuss your own personal issues about medication adherence.

36 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 36 Adherence admonition Even if you are doing well maintaining health long-term takes thought and planning Even if you are doing well maintaining health long-term takes thought and planning We need a specific behavioral plan. We need a specific behavioral plan. Remember: Adherence is more difficult than it seems!

37 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 37 Adherence skills: overview, 1  Cue controls: associate doses with your ongoing daily routines  Reminders: pill box, computer warnings… (not post-it notes!).  Timers: alarm watch, palm pilot… Make concrete, specific plans. Make concrete, specific plans Do not rely on personal memory Use your environment to help memory: Use your environment to help memory: Basic assumptions of adherence skills

38 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 38 Adherence skills: overview 2 Track if you have taken each dose Track if you have taken each dose Be a reminder Be a reminder 2. Track doses. Use a pill box to: Why did I miss? What was going on? What should I change? New planning? Analyze a missed / late dose: Analyze a missed / late dose:

39 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 39 Adherence skills: overview 3 When will it be difficult to take your meds? When will it be difficult to take your meds? How can you plan for those times? How can you plan for those times? 3. Pre-plan for difficult doses Concrete and specific Concrete and specific Tailored to your situation Tailored to your situation What plans work best? What plans work best?

40 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 40 Adherence skills: overview 4 Who has supported you in HIV? Who has supported you in HIV? What has helped you get support? What has helped you get support? Who has been harmful? Who has been harmful? Where do you feel you might need more support? Where do you feel you might need more support? Disclosure: who can you talk to about treatment, sexuality, etc. Disclosure: who can you talk to about treatment, sexuality, etc. 4. Get support from others

41 UIC / HBHC Treatment Advocacy Program Main Menu ( click one): TAP: Medication skills 1, basic skills 12/9/03 41 Pill box screen Do you use a pill box? No Yes Let’s begin reviewing basic pill box skills…

42 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 42 Go back to pill box scale Advocate: please go back and click on one answer

43 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 43 No pill box What keeps you from using one? What keeps you from using one? What made it inconvenient? What made it inconvenient? Other barriers? Other barriers? What would make you more likely to use one? Have you ever tried a pill box?

44 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 44 Pill box How has it helped you keep track or take doses? How has it helped you keep track or take doses? What has been inconvenient? What has been inconvenient? What changes would help? What changes would help? How has your pill box worked out?

45 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 45 Basic Treatment Skills: The Pill Box Track whether you took each dose. Track whether you took each dose. Keep in sight as a reminder. Keep in sight as a reminder. Fill to store all your medications. Fill to store all your medications. Where & when can you fill it each week? Where & when can you fill it each week? Four boxes for complete monthly doses? Four boxes for complete monthly doses? Separate mid-day box? Separate mid-day box? Where can you put it as a visible reminder? Where can you put it as a visible reminder? Do you need to keep it from others (children…)? Do you need to keep it from others (children…)? Let’s review the overall pill box approach: Fill pill box

46 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 46 Basic Treatment Skills: The Pill Box (cont.) What happened to make you miss? What happened to make you miss? What could help next time: new plans? What could help next time: new plans? Talk to your advocate about it at the next visit! Talk to your advocate about it at the next visit! Tracking missed doses What if you see a dose still in your pill box? 1. Follow the half time rule: 2. Self monitor: Less than half way to next dose, take your pills. Less than half way to next dose, take your pills. More than half way, skip. More than half way, skip. A missed dose is a learning opportunity!

47 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 47 Basic Treatment Skills: Personal Cue Control Plan Timers? What can cue your morning dose? a.m. bathroom? Shaving / hair / coffee? Before breakfast? What can cue your evening ( mid-day…) dose? T.V. / Reading / internet? Dinner or p.m. Snack? Visual cues? Refrigerator note? Bathroom mirror? Pill box!! Alarm watch? Beeper? Personal cue controls Medication Overview Sheet

48 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 48 Basic Treatment Skills: Emergency Dose In general? In general? At work? At work? While with a new sex partner? While with a new sex partner? Out for the evening / at a club? Out for the evening / at a club? Not sleeping at your own home? Not sleeping at your own home? How do you carry a dose & water? Who can keep a spare dose for you? Where? Where? How will you talk to them about it? How will you talk to them about it? Keeping an “emergency” dose

49 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 49 Treatment Skills: Talking to your HIV care Provider Let’s go to a new topic… …Talking to your HIV medical provider Who do you see for HIV medical care?

50 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 50 Treatment skills: Talking to your provider, 1 What questions are you able to ask? What questions are you able to ask? What topics are hard to talk about? What topics are hard to talk about? Are you confident that you understand your treatment? Are you confident that you understand your treatment? How could the medical staff better support you? How could the medical staff better support you? How comfortable are you talking to your HIV provider?

51 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 51 Treatment skills: talking to your provider, 2 Make a list!!… of all your questions! Compile a list now? Write down the main topics to cover: Medication schedule? Medication schedule? Side effects? Side effects? Possible STD symptoms? Possible STD symptoms? Nutrition / diet, exercise, etc? Nutrition / diet, exercise, etc? Think of how to ask about each one: How long after a meal should I take..? How long after a meal should I take..? How long should my nausea last? How long should my nausea last? Some skills for talking to your provider:

52 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 52 Treatment skills: Talking to your provider, 3 Ask your provider to use language you understand. Could you say that in different words? Could you say that in different words? I am not sure I understand that. I am not sure I understand that. How can you make sure you understand? So you mean that… So you mean that… What I understand is… What I understand is… Restate it in your own words!

53 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 53 Treatment skills: Talking to your provider, 4 what if this makes me sick? what if this makes me sick? what else will these drugs do? what else will these drugs do? how will this affect my…diabetes / hypertension? how will this affect my…diabetes / hypertension? what happens if I drink or get high while taking these? what happens if I drink or get high while taking these? State your concerns or fears directly. Never be embarrassed about… How can you talk openly about concerns? Use open communication: Not knowing something Not knowing something Being concerned or anxious Being concerned or anxious

54 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 54 Treatment skills: Talking to your provider, 5 How can you state it clearly? How can you state it clearly? What if you do not understand my answer? What if you do not understand my answer? How could you ask for me to clarify it? How could you ask for me to clarify it? Let’s practice talking to your provider Let’s take one of your concerns or questions.

55 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 55 Summary: Being Prepared for Treatment… We discussed adherence & sexual safety. We discussed adherence & sexual safety. We covered the basic concepts. We covered the basic concepts. Adherence = all pills, on time Adherence = all pills, on time Key terms: Viral load, resistance, T cells / CD4 Key terms: Viral load, resistance, T cells / CD4 Health = sexual safety + treatment adherence Health = sexual safety + treatment adherence You have a med schedule & “cues”. You have a med schedule & “cues”. Your pillbox can keep track of doses. Your pillbox can keep track of doses. We have a plan for talking to your provider We have a plan for talking to your provider That finishes our material for today.

56 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 56 Checking in About today’s visit How did it feel to talk with me about these topics? Did we get a chance to discuss the topics that are important to you? How could we have addressed your concerns better?

57 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 57 Scheduling Your Next Visit… Next week we will… Review how your meds are going. Review how your meds are going. Analyze any missed doses. Analyze any missed doses. Discuss “difficult doses” & talking to your HIV doctor. Discuss “difficult doses” & talking to your HIV doctor. Is _______ / _______ still the best day and time for your next visit? Remember: Call or if you have any questions or concerns.

58 UIC / HBHC Treatment Advocacy Program Main Menu TAP: Medication skills 1, basic skills 12/9/03 58 Advocate’s notes & checklist Advocate: Visit Checklist  Coping interview form  Medication overview & cue control chart copy for file  Pill box filled & reviewed  Referral sheet (if used)  Next appointment hand card distributed Complete Counseling Notes Form and Visit Log for file.


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