1. COMPUTER ALERT SYSTEM AND TELEPHONE SUPPORT TO IMPROVE ANTIRETROVIRAL THERAPY ADHERENCE Kasparas, Gustavo Guillermo (1); Iannella, María del Carmen (2);Bugarin, Gabriela (1); Miro, Roxana (1); Belforte, Marcela (1); Visciglio, Hugo (3); Bologna, Rosa (1); Cassetti, Isabel (1) Organization(s): 1: Helios Salud, Argentina; 2: Universidad de Buenos Aires; 3: Infhos. Contact e-mail: kasparas@fibertel.com.ar

2. INTRODUCTION Poor adherence to antiretroviral therapy (ART) is a major obstacle to successful treatment outcomes 1,2 There is evidence that telephone support improves adherence in several medical areas 3 In developing countries mobile phones are widely used 4 The registry of medication dispensed is an indirect method to assess adherence with acceptable sensitivity and specificity 5 1.Wood E et al, J Acquir Immune Defic Syndr 2004; 35(3):261-268. 2.Garcia de Olalla P et al, J Acquir Immune Defic Syndr 2002; 30(1):105-110. 3.Lester RT et al, The Lancet 2010; 376 (9755):1838-1845. 4.The real digital divide. The Economist 10 March 2005. 5.Pérez-Simón MR et al, Med Clin (Barc) 2003; 120 (18):701-3.

3. OBJECTIVE To evaluate the efficacy of an adherence strategy based on a computer alarm system and telephone support intervention

4. METHODS (I) Setting: A private specialized medical center in Buenos Aires City and affiliates in the provinces. Design: Retrospective comparative intervention cohort study. The comparator referred to was the year 2006. In 2007 a newly installed computer alert system began to identify any delay in ART dispensing. Adherence strategies of telephone support were applied. Data from 2007, 2008 and 2009 were compared against 2006. The rates of dispensed ART were compared as indirect indicators of adherence.

5. METHODS (II) Intervention: Adherence strategies for telephone support Psychologists, social workers and persons living with HIV were trained in : 1.HIV/AIDS counseling 2.Communication skills 3.Computer skills 4.Team work skills 5.Confidentiality policy Outcome Measure: Yearly rate of pharmacy dispensing with respect to the baseline

6. METHODS (III): Study Population TABLE 1. Medical Monitoring Population: 2006 to 2009 2006 a 2007 b 20082009 N° of Patients3,3193,4304,0404,584 Age, mean years37.0 (SD11.5)37.3 (SD11.3)37.7 (SD11.2)38.4 (SD11.4) With ART,%73.275.576.577.2 Without ART,%26.824.523.522.8 Male,%67.266.967.767.5 a Year 2006: Baseline comparator b Year 2007: Start of the warning computer system and telephone support adherence to ART

7. FLOW CHART OF THE INTERVENTION

8. TABLE 2. HAART pick-up rates, rates of VL studies <50 copies / mL, and median CD4 cell count Year2006 a 2007 b 20082009 HAART pick up, % (95% CI) 78.1 (77.58 - 78.59) 81.4 (80.97 - 81.888) 81.0 (80.52 - 81.37) 83.2 (82.85 - 83.60) VL <50 copies / mL,%, (95% CI) 53.7 (52.25 - 54.99) 59.6 (58.24 - 60.88) 62.7 (61.52 - 63.95) 69.3 (68.17 70.36) CD4 cells / mL, median (IQR) 436 (292-615) 422 (285-593) 447 (306-616) 476 (327-651) a Year 2006: Baseline comparator b Year 2007: Start of the warning computer system and telephone support RESULTS (I)

9. RESULTS (II) Figure 1. HAART pick-up rates of pharmacy vs. Baseline (2006)

10. Figure 2. Percentage of studies with VL <50 copies / mL RESULTS (III)

11. POLICY IMPLICATION & CONCLUSION Our findings show that centralized data of pharmacy dispensing, with a computer alarm system for any delay and telephone support improves long-term adherence to ART and clinical outcomes. Mobile telephones are widespread, even in the poorest countries in the world. This gives health care givers the opportunity to communicate with patients and thus strengthen adherence to treatment. Health policies that centralize computerized data and encourage the training of staff may promote the replication of these interventions tailored to other different settings. This experience requires the work of members of different areas, which involves the development of teamwork skills. Supervision, coordination and training of people in charge are necessary in order to prevent this intervention from becoming a purely administrative and inefficient task.

12. Gustavo G. Kasparas Contact e-mail: kasparas@fibertel.com.ar THANK YOU