Open AccessThe effect on survival of a multidimensional intervention project (SEAD) in HIV/AIDS patients with follow‐up and adherence (FUP/ADH) barriers
Author(s) -
Pérez Elías M,
Elías Casado L,
Pumares M,
Moreno A,
Dronda F,
Muriel A,
Casado J,
Quereda C,
Del Palacio M,
Hermida J,
Navas E,
Rodriguez Sagrado M,
Moreno S
Publication year - 2012
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.15.6.18396
Subject(s) - medicine , psychological intervention , intervention (counseling) , population , human immunodeficiency virus (hiv) , logistic regression , family medicine , psychiatry , environmental health
Purpose of the study Irregular FUP/ADH were associated with higher mortality and resource use [1]. SEAD was a multidimensional intervention project, designed from the patient's perspective, to specifically attend patients with poor FUP/ADH in an HIV/AIDS outpatient clinic. Methods From Jan 2006 to May 2010, patients with poor FUP/ADH were offered SEAD inclusion, all were evaluated by a nurse or a psychologist (adherence collaborators) who assessed all the reasons and barriers precluding a correct FUP/ADH. For each identified problem, different interventions were planned, using our own resources or coordinating others. Follow‐up was censored in Nov 2011. Time to death after being admitted to SEAD and the effect of SEAD program intervention were assessed with Kaplan‐Meier curves, log‐Rank test and a Cox regression model. Summary of results Overall, 215 patients were assessed: mean age 45 years, 24% women, IDU 75%, with baseline ADH >90% in only 23%; median HIV‐RNA and CD4 cell count were 377 copies/ml and 326 cell/mcL. Patients entered in SEAD due to poor ADH in 17%, FUP problems in 23%, and both 60%. Main reasons driving poor FUP/ADH were severe bio‐psycho‐social problems 28%, severe drug and/or alcohol abuse 26%, logistic problems 18%, other psychiatric disorders 13%, oversights 9%, unknown 4% and antiretroviral intolerance 2%. Only 54% of patients received;>50% of planned interventions, due to population complexity. Cocaine/heroin and alcohol abuse were reported by 34% and 17% respectively. Afer a median follow‐up of 3.7 [3.31–4.4] years 193 patients received a mean of 8 (2.5–12) interventions/year, achieving virological control in 64%. Probability of survival was 92%, 89% and 86% after 1, 2 and 3 years respectively. In Cox regression model an intervention of SEAD project higher than 50% of planned was an independent predictor of survival HR 0.336 (95% CI 0.156–0.725); p=0.005, after adjusting for age, alcohol or cocaine abuse, psychological attention, degree of adherence and follow‐up, intravenous acquisition of HIV, and family support. Alcohol and cocaine abuse were associated with higher mortality HR 2.964 (95% CI 1.378–6.374); p=0.005 and HR 2.444 (95% CI 1.161–5.145); p=0.019. Conclusions Being admitted to SEAD intervention project and receiving more than 50% of planned interventions increased survival expectancy.