QUALIAIDS TEAM STUDIES IN BRAZIL
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1 QUALIAIDS TEAM STUDIES IN BRAZIL Maria Ines Battistella Nemes Associate Professor / Preventive Medicine Department / Faculty of Medicine of University of Sao Paulo ADHERENCE Prevalence of patient adherence to ART (2000/02/10) Pragmatic clinical trial of an adherence intervention (2008) PERFORMANCE OF HIV CARE FACILITIES M&E care process and management of HIV care sites (2001/07/10/14) M&E HIV prevention in primary care sites (2014) M&E tuberculosis-hiv reference centers (2014) Monitoring adherence rates in HIV care sites (2014)
2 *Brazil provides universal and free access to ART BRAZILIAN* CASCADE, 2012
3 Adherence in the new ART era Sustainable high level of ART adherence remains essential for achieving good clinical outcomes as well as for preventing HIV transmission Adherence is a dynamic process NEED OF ADHERENCE MONITORING
4 ART adherence monitoring in different contexts INDIVIDUAL CONTEXT: seeking better individual care ORGANIZATIONAL CONTEXT: seeking better facility performance RESEARCH CONTEXT: seeking better accuracy of the measure
5
6 ART adherence rates assessing the performance of facilities: Self report-based adherence from exit interviews Dispensing-based adherence Patient attendance
7 ART adherence rates assessing the performance of facilities: Web-based self-report anonymous adherence questionnaire
8 Video: 2 MINUTES
9 Web-based self-report questionnaire to monitor patients adherence to ART in the Brazilian public HIV care facilities
10 The following questions will help this facility to evaluate how people are taking their drugs.
11 Your participation is totally anonymous. You will not be identified.
12 Hi! My name is Silvia.
13 And how about you? In the last 7 days, have you taken any of the drugs of the cocktail at times other than those scheduled by your doctor? 1Yes 2No 3I do not know/do not recall
14 And how about you? In the last 7 days, have you failed to take any of the drugs of your cocktail? 1Yes 2No 3I do not know/do not recall
15 In the last 7 days, have you taken less or more pills of any of the drugs of your cocktail? 1Yes 2No 3I do not know/do not recall
16 WebAd-Q: scale of non-adherence Adherence Scale Q1 Q2 Q3 0 0 non-adherence answer 1 1 non-adherence answer 2 2 non-adherence answers 3 3 non-adherence answers Non- Adherence
17 WebAd-Q: validation 75 patients using MEMS for two months prior to the WebAd-Q WebAd-Q answers compared to other adherence measures: MEMS, pill counting, 3-day self-report interview WebAd-Q scale compared to viral load Concordance betwen 2 patient responses (minimum 1 hour-interval)
18 Correlation between WebAd-Q scale and viral load (n=75) Non-adherence scale Mean SD N Correlation p <
19 Concordance observed and Kappa Coefficient for the two patient answers to WebAd-Q questions (n=75) Question Observed concordance Kappa (IC 95% ) p Q ( ) < Q ( ) < Q ( ) 0.01 Q1-Q ( ) <
20 WebAd-Q: feasibility (research settings) Survey: 55 Brazilian facilities randomly chosen 2424 respondentes No difficulty reported by patients Minimal glitches (0.8%) Response time (4.5 minutes median) Qualitative study: 29 interviewed health providers Simple, objective, user-friendly, easy to implement Useful to improve adherence related strategies
21 WebAd-Q: ongoing application in real world settings User`s guide 10 different-size facilities (3 high, 2 medium, 5 low) Prior technical visits + Two-hour training
22 WebAd-Q: feasibility ( real world settings)
23 WebAd-Q: feasibility ( real world settings) Preliminary results from 8 facilities Facilities Days since installation Number of respondents Number of patients receiving ART % of respondents Index % % % % % % % 0.1 * 1 facility is not using the tool
24 WebAd-Q access (questionnaire and database) www2.fm.usp.br/webad-q To try: 4 digits + 0 (Ex: 55550) The system generates an Excel spreadsheet containing answers and the correspondent scale
25 Monitoring adherence rates in HIV care sites strategies to promote adherence subject of discussion among the health care team proxy measures of performance general care quality
26 QUALIAIDS TEAM: future directions National implementation of routine adherence monitoring Definition of care organization priorities and best practices to promote retention and adherence
27 Cooperation agreement University of São Paulo Medical School and Yale University
28 Thank you! Muito Obrigada! Ines Well, it was a pleasure talking to you. Thank you for answering these questions. Goodbye!
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