Kimberly PPt

AIDS in Jamaica: 

AIDS in Jamaica A social support-based approach to increasing adherence to ARV treatment Kimberly Bardy

Project:ARV Adherence in Jamaica: 

Project: ARV Adherence in Jamaica Group project for SHH 231 Amazing group members: Jeffrey Blander Rebecca Firestone Sarah Oppenheimer In coordination with Jamaica AIDS Support and Jamaica Ministry of Health

HIV/AIDS in the Americas: 

HIV/AIDS in the Americas Source: Caribbean Epidemiology Centre

AIDS in Jamaica: 

AIDS in Jamaica Source: Ministry of Health, Jamaica AIDS Report 2002

AIDS in Jamaica: 

AIDS in Jamaica Source: National AIDS Committee, Jamaica

Addressing the Epidemic: High-Income Countries : 

Addressing the Epidemic: High-Income Countries Antiretroviral treatment Primary goal is suppression of viral replication Optimal treatment is combination therapy Reduces risk of HIV disease progress and death HIV as a “manageable chronic disease”

Addressing the Epidemic: Jamaica: 

Addressing the Epidemic: Jamaica Until recently, ~400 people had access to ARV in Jamaica In May 2004, The Global Fund granted $23 million to Jamaican MOH to: Increase access to care for PLWHA Protect rights of PLWHA Prevent spread of HIV Minimize social and economic impact of HIV/AIDS Roll out ARV treatment

ARV Treatment in Jamaica: 

ARV Treatment in Jamaica Complexities of ARV treatment Regimen Adherence Multi-drug resistance Self-efficacy and social support positively associated with ARV adherence Finances and stigma are major barriers

Our Proposal: MDOT+: 

Our Proposal: MDOT+ Cluster-randomized community intervention trial Social cognitive theory-based Ecological framework Modified Directly Observed Treatment System, Plus (MDOT+) Effectiveness trial

Research Question: 

Research Question Can a comprehensive, coordinated approach to ARV treatment provision that includes enhanced adherence resources and strategies, social support, and anti-stigma campaigns ensure a higher level of medication adherence among people beginning treatment as compared to those receiving the standard of care?

Study Objectives: 

Study Objectives Primary Objective: To test an intervention that is effective in encouraging greater ARV treatment adherence among PLWHA in Jamaica. Secondary Objectives: Increase self-efficacy for ARV treatment. Decrease stigma against PLWHA. Increase social support among PLWHA, home-based caregivers. Increase knowledge about HIV/AIDS & ARV treatment among PLWHA, home-based caregivers, and healthcare workers. Establish adherence maintenance.

Study Design: 

Study Design Cluster-randomized community intervention Longitudinal cohort design Population-centered approach

MDOT+ Intervention Design: 

MDOT+ Intervention Design Modifying Factors Housing Family relations Nutrition Mental health status Income Employment Drug use MDOT+ Intervention Standard of Care Plus Treatment preparedness education and counseling Modified directly observed treatment Psychosocial support Quality of care improvements Community-based stigma reduction Mediating Mechanisms Increased self-efficacy Decreased stigma Increased social support Behavioral Outcomes Adherence to Rx Disease Outcomes Increased CD4 counts Weight gain Reduced OI incidence Improved length and quality of life Control Groups Standard of care treatment

Treatment Groups: 

Treatment Groups

?QUESTIONS?: 

?QUESTIONS? Effectiveness vs Efficacy Realistic design Outcome monitoring Achieving results with only two clusters/study arm Cost

Thanks!: 

Thanks!