Patient Navigation Intervention. Basic Lab Work & Adherence

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1 Enhanced Patient Navigation for HIV - Positive Women of Color Patient Navigation Intervention Basic Lab Work & Adherence

2 Educational Session Understanding Your Lab Work and the Importance of Medication Adherence For this session, we will review: 1 Lab Work 2 Monitoring Lab Work 3 Taking HIV Medications 4 Managing Challenges 5 Adherence

3 Understanding Your Lab Work Laboratory tests can help you keep track of your health. Depending on your immune status, whether you are on medication or not, and a variety of other factors, your provider will set up a schedule of visits for you to monitor your health.

4 Understanding Your Lab Work Baseline Lab Work Is done shortly after you find out you have HIV, these tests establish a starting point or "baseline." Ongoing Lab Work Future tests will let you know how far from this baseline you have moved. This can help you tell how fast or slow the disease is moving and indicate whether treatments are working. This is why its important to come in for your lab work and get your blood drawn every 3-4 months*

5 Understanding Your Lab Work Trending Most labs include a "normal" range (high and low values) when they report test results. The most important results are the ones that fall outside these normal ranges. Test results often go up and down over time so don't worry about small changes. Instead look for overall trends.

6 Understanding Your Lab work Blood Tests Specific to Monitoring Your HIV Helper T-Cells CD4 Cell Count Viral Load Count Complete Blood Count Blood Chemistry-Screen (CS) Test Complete Blood Count (CBC) Fasting Lipid Profile Opportunistic infections HIV Genotype Routine Screening Tuberculosis (TB) Test STD Screening Hepatitis A, B, and C

7 Understanding Your Lab work Type of Lab Tests Reason for Lab Tests 1. Helper T-Cells how well your immune system is functioning 2. CD4 how well your immune system is functioning 3. Viral Load how rapidly HIV is replicating, or multiplying 4. Complete Blood Count how to evaluate overall health & detect disorders 5. Blood Chemistry how well your body and organs are functioning 6. Blood Pressure how well the force & rate of the heartbeat is 7. Fasting Lipid Profile how healthy your heart is 8. Liver Function how well your liver is working 9. Kidney Function how well your kidney is working 10. Opportunistic Infections whether you have other diseases associated with HIV 11. HIV Genotype whether the virus in your body is resistant to other ARVs 12. Routine Screening how preventive care is used to maintain your health

8 Key Lab Tests 1. CD4 2. Viral Load 3. HIV Genotype We re not going to cover all 12 lab tests in this session, just the most common ones: CD4 count, viral load count, and HIV genotype, etc. These critical tests tell a story about your health and what needs to be done to keep you healthy.

9 Blood Work CD4 Cells CD4 cells are a type of white blood cell (lymphocyte) that fights infection. Another name for them is Helper T-Cells. CD4 cells are made in the spleen, lymph nodes, and thymus gland, which are a part of the lymph or infection-fighting system. These cells protect you from viral infections; help other cells fight bacterial and fungal infections; produce antibodies; fight cancers; and coordinate the activities of other cells in the immune system

10 Blood Work CD4 Cell Count CD4 cells are the prime target of HIV, which can cause the number of these cells to increase over time. As HIV disease progresses, the CD4 cells fall from a normal count of 500-1,500 down to as low as zero. Too few CD4 cells means that the immune system will no longer function like it is suppose to. When the CD4 cell count goes below 200 A person is diagnosed with AIDS There is an increased risk of opportunistic infections.

11 Blood Work CD4 Cell Count The higher the CD4 count the better Knowing how many CD4 cells you have, can tell you how healthy your immune system is and how well it is holding up in the fight against HIV. Your CD4 cell count will also be helpful in figuring out when to start antiretroviral (ARV) therapy and whether or not you should start taking medications to prevent AIDS-related infections.

12 Blood Work Viral Load Count The viral load count measure the amount of HIV in a drop of blood If only a small amount of virus is present (between 40 and 75 copies of virus depending on the test), then the test cannot detect the virus. This is what is meant when a viral load count comes back with a result of undetectable.

13 Blood Work Viral Load Count While taking therapy, your viral load report might show that HIV can no longer be detected. This is know as having an undetectable : viral load. However, this does not mean that HIV is not present in your body since less than 5 percent of HIV in the body can be found in the blood.

14 The Importance of Monitoring How blood work is used It is important to regularly monitor blood work to: 1. Determine when medications should be started. 2. Determine if medications are working correctly When using HIV medications, the ultimate goal is to reduce the viral load to undetectable. If your viral load becomes detectable or continues to increase while you are on treatment, it may be necessary to switch your regimen to control the virus and to protect your CD4 cells and health.

15 The Importance of Monitoring HIV Genotype Also know as a resistance test, the HIV Genotype test determines whether or not the virus in your body is resistant to other anti-hiv medications.

16 Question Have you had lab work done? Let s review your lab work to ensure that you understand the different labs that are monitored. We can also track your results on a spreadsheet or a grid. That way you can monitor independently and increase understanding of labs and your health. Always ask for a copy of your labs and keep them in one place so that if you move or change physicians, your new physician has a history of your care and treatment.

17 HIV Medications Challenges Additional responsibility Scheduling Side effects Fatigue Commitment Benefits Availability of a support team Availability of easier, less complicated regimens Controls progression of HIV Give your immune system a fighting chance Maintains good, stable health Can live a longer and fuller live

18 Managing Side Effects Many side effects are related to your digestive system, such as nausea, diarrhea, bloating, and gas. Many people manage these with other medications or food. BRAT diet: Bananas, Rice, Applesauce, and Toast Apples and apple products like apple juice and apple sauce Black or green decaf tea Boiled white rice White toast Ginger and ginger products like ginger tea, candied ginger, ginger ale, ginger snaps, etc. Yogurt Soda crackers or saltines Fiber-rich foods or supplements Medication: Imodium AD (loperamide)

19 Managing Scheduling Unable to maintain a regular, consistent schedule for taking medications There are many methods and tools (e.g. pillboxes, calendars, alarm watches, etc.) available to help

20 Medication Adherence Medication adherence usually refers to whether patients take their medication as prescribed, as well as whether they continue to take a prescribed medication.

21 The Importance of Adherence For the challenges previously discussed, most but not all people will experience an increase in CD4 cell with effective HIV treatment. Most often these challenges can impact one s ability to take medications on a consistent basis. Taking medications on a regular, consistent scheduled is called adherence.

22 Adherence Adherence means sticking to your medication schedule at least 95% of the time. It means taking your meds correctly and on time every day.

23 Viral Load and Non-Adherence

24 References Iowa Healthcare Collaborative (IHC) Minnesota Health Literacy Partnership (MHLP) American Medical Association (AMA) Agency for Healthcare Research & Quality (AHRQ) Centers for Disease Control and Prevention (CDC) Institute of Medicine Institute for HealthCare Improvement Wikipedia

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