© 2007 Baylor College of Medicine Impact of In-Reach Program On Adherence in Botswana Selolwane, G., Machine, E., Adegbite M, Selolwane, G., Machine, E.,

© 2007 Baylor College of Medicine

Impact of In-Reach Program Impact of In-Reach Program On Adherence On Adherence

in Botswanain Botswana

Selolwane, G., Machine, E., Adegbite M, Selolwane, G., Machine, E., Adegbite M, Karugaba G., Mullan, P., Phelps R; Anabwani, G.;Karugaba G., Mullan, P., Phelps R; Anabwani, G.;

BIPAI Network Meeting 2008BIPAI Network Meeting 2008

© 2007 Baylor College of Medicine

Objectives of this presentation Objectives of this presentation To outline the Botswana In-

Reach Program To show ARV adherence trends

among In-Reach patients Make inference on the impact of

the program Identify ways of strengthening/

improving the In-Reach program

© 2007 Baylor College of Medicine

In-Reach Program definedIn-Reach Program defined Program whereby children already enrolled

at the COE clinic are visited at their homes

Refers to home based community support for HIV+ children

Based on experience, assumes that patients failing treatment are largely as a result of psychosocial problems rooted in the home environment

A failing patient would be better managed by carrying out home visits to better understand the home environment

© 2007 Baylor College of Medicine

In-Reach Program definedIn-Reach Program defined

Adherence of between 95% and 105% is highly recommended for ARVs to avoid resistance and toxicity respectively

BBCCCOE has identified children with inadequate adherence and other risk variables (caregiver instability, food insecurity, etc)

These selected children and their caregivers receive additional adherence counseling and attend additional didactic teaching sessions. Failure in these measures leads to referral for In-Reach

© 2007 Baylor College of Medicine

Methods Methods Retrospective study Data was extracted from patients who

have been followed up through the In-Reach program

For each patient we tracked objective adherence % at baseline and thereafter

© 2007 Baylor College of Medicine

MethodsMethods

There were 98 patients with adherence problems who qualified and who were referred for in reach follow up.

We report on 29 patients with complete records.

© 2007 Baylor College of Medicine

CM Number

Adherence % at baseline

Adherence FU01

Adherence FU02

Adherence FU03

Adherence FU04

Adherence FU05

54656 86% 97% 99% 100%    

61379 88% not possible 96%      

62945 78% 100% 97% 100%    

57227 93% 95%   98%    

55220 50% 100% 100% 100%    

62282 108%   100% 97%    

56700 77% 100% 100%      

64958 87% 90% 100% 100%    

55782 97% 100% 100% 99% 100%  

56364 100% 100% 88% 100% 86% 100%

58228 75% 99% 99% 102% 99% 100%

63441 90% OFF 92% 100% OFF 96%

54415 86% 100% 98% 98% 97%  

57700 94% 86% 93% 100% 100% 98%

55633 76% 99% 100% 102% 100%  

56615 80% 80% not pos. 99% 88%  

54725 93% 100% 100% 100%    

61832 88% 100% 100%   98%  

62664   100%   90% 104%  

55865 90% 100% 100% 100% 100%  

54917 87% 98% 98% 98% 100%  

55370 75%   95%      

55578 59% 97% 100%   Meds OS 100%

80094 85% 81% OFF not poss. 94% 100%

56294 POOR 101% 100% 101% 100%  

55564 81% 98% 98%      

56535 84% 141% 102% 100%    

56499 64% 114% 105% 100%    

77949 84% 96% 100%      

Mean

© 2007 Baylor College of Medicine

Example PatientExample Patient

CM Number Adherence % at baseline

Adherence FU01

Adherence FU02

Adherence FU03

Adherence FU04

Adherence FU05

58228 75% 99% 99% 102% 99% 100%

© 2007 Baylor College of Medicine

FindingsFindingsImpact of Home-visits on Adherence Levels

0%

20%

40%

60%

80%

100%

120%

Adherence % atbaseline

Adherence FU01 Adherence FU02

Follow-up visits

Ad

her

ence

%

© 2007 Baylor College of Medicine

FindingsFindings

Impact of Home-Visits on Adherence levels

0%

20%

40%

60%

80%

100%

120%

140%

160%

Adherence % atbaseline

AdherenceFU01

AdherenceFU02

AdherenceFU03

Follow-up visits

Adh

eren

ce %

© 2007 Baylor College of Medicine

FindingsFindingsImpact of Home Visits on Adherence Levels

0%

20%

40%

60%

80%

100%

120%

Adherence% at

baseline

AdherenceFU01

AdherenceFU02

AdherenceFU03

AdherenceFU04

Follow-up Visits

Ad

her

ence

%

© 2007 Baylor College of Medicine

FindingsFindingsImpact of Home Visits on adherence levels

0%

20%

40%

60%

80%

100%

120%

140%

160%

Adherence% at

baseline

AdherenceFU01

AdherenceFU02

AdherenceFU03

AdherenceFU04

AdherenceFU05

Follow up visits

Ad

her

ence

%

© 2007 Baylor College of Medicine

ObservationsObservations

© 2007 Baylor College of Medicine

Observations Observations After the home visits have been initiated,

we observed that adherence levels improved.

Through home visits, we discover strengths as well as weaknesses and intervene accordingly.

From the results above, the trends serve to show that the In-reach program has a positive impact on adherence

© 2007 Baylor College of Medicine

Lessons learntLessons learnt The home visits can be scaled up to include

other aspects beyond adherence

We did not separate our results between medicine formulation. It will be more informative to observe adherence trends in pills and liquid medications separately

It would also have been useful to have the adherence trends before the intervention of home visits for comparison

© 2007 Baylor College of Medicine

Management team at the BBCCCOE Edwin Machine Grace Karugaba Nkumbuludzi Ndwapi

© 2007 Baylor College of Medicine