1. AIDS Community Health Center Treatment Adherence Program CHC Quality Learning Network AIDS Institute April 12, 2007 Roberto Corales, D.O. Danita Djeloski, MD AIDS Community Health Center

2. Presentation Goals  Overview of Program’s Approach to ARV Management and Role of Adherence  Quality Improvement Projects  Issues Related to Sustaining Gains

3. Treatment Adherence Program approach to ARV Management  Rationale  First regimen success is best  Factors of poor adherence   Psychiatric co-morbidities   Substance abuse   Dual roles/psychosocial issues   Adverse effects   Poly pharmacy  Direct Observe Therapy (D.O.T.)  Patient Education, Empowerment, Responsibility

4. Treatment Adherence Program approach to ARV Management  Description of ACHC TAC Approach   Clinical input versus recording tool   Initial Referral process   Follow up visits   Annual Screening   Weekly interactive group meetings   DOT

5. Treatment Adherence Program approach to ARV Management  Strengths   Part of multi-disciplinary team approach   Medication list   Medical quality assurance (CME, lectures, conferences, self-read)   3-year increased patient satisfaction in the Treatment adherence program   Clinical Studies  Improvements   Graduating from the program   Reducing the no-show rate (currently 10%)   Secured medication storage for weekly follow ups and D.O.T

6. Quality Improvement Projects  Weekly clinical sessions with pharmacist   Drug-drug interaction   Pharmacokinetic  Results:   Increased understanding of mechanism of drug-drug interactions and drug contraindications   Increased knowledge of basic pharmacokinetics of different HIV medications   Knowledge gained transfers to patient   TAC-Patient trust   Improvement in patient satisfaction (annual survey)

7. Quality Improvement Projects  Weekly treatment adherence group meetings   Educational topics   Mediator – patient interaction   Guest lecturers  Results:   Patients support group   Increased knowledge of basic issues with adherence   Increase % adherence (HIVQUAL indicator)   Improvement in patient satisfaction (annual survey)

8. Quality Improvement Projects  Weekly case management team   Communication with clinical team members   Feedback loop mechanism  Results   Better understanding of overall patient clinical and psychosocial issues   Improve patient satisfaction (annual survey)   Improve patient % adherence (HIVQUAL indicator)

9. Quality Improvement Projects  Prior authorizations   Role in assisting with acquiring prior authorizations   Heightened awareness of medical pharmaco-economics   Increase in knowledge of drugs in specific class  Results:   Efficiency in prescription turn around   Improvement in patient satisfaction (annual survey)   Improvement in % adherence (HIVQUAL) indicator

10. Quality Improvement Projects  Weekly HIV lectures   Interactive approach with selected topics per semester with assigned readings   Increase knowledge   Core HIV pathophysiology, ARV management, Adverse events, Adherence  Results   Improved TAC knowledge of HIV and ARV management for better counseling with patients   Improve patient satisfaction (annual survey)

11. Quality Improvement Projects  Recommendation  Establish internal QA/QI committee  Assess deficiencies in HIVQUAL and annual patient satisfaction survey  Address deficiencies   PDSA project   Strategy – Goal – Action – Timeline  TAC continuing education   seminars, self-CME, classes

12. Issues Related to Sustaining Gains  Organizational Experience   More clinical approach   Increased active participants in weekly groups   Meet and exceed AIDS Institute goals   Number of actively enrolled patients   Improved % adherence (HIVQUAL indicator)   Improvement of overall 3-year patient satisfaction   Involvement in clinical trials