Transcript Tyeshia Halsell

How can PA’s promote
medication
compliance/adherence in
African American women
infected with HIV?
Tyeshia Halsell
April 6, 2006
PA Master’s Project
Advisor: Professor Fahringer
What is HIV/AIDS?
HIV stands for “human immunodeficiency virus”:
“human” because the virus causes disease only in
people; “immunodeficiency” because the immune
system, which normally protects a person from
disease, becomes weak; “virus” because like all
viruses, HIV is a small organism that infects living
things and uses them to make copies of itself.
There are two types of HIV: HIV-1 and HIV-2. HIV1 is found in all parts of the world but HIV-2 is found
mostly in West Africa, but both viruses can be
prevented in the same ways (Granich & Mermin,
1999).
What are the three
barriers identified?
1. Physician Assistant-Patient
Relationship
2. Dealing with and treating
psychosocial distress/stress of
living with HIV/AIDS
3. The impact of alcohol, and
recreational drug use
PA-Patient Relationship
Knowledge of the client’s background will guide
which behaviors are appropriate and beneficial to
accept in order to gain the favorable rapport that will
enhance treatment (Kelly et al., 1987; Katz et al.,
1987; Hunter & Ross, 1991).
The PA must appreciate within-group cultural
diversity and refrain from generalizing knowledge
about one subgroup of a minority population to all
members of that broader population.
Dealing with & treating
psychosocial distress/stress of
living with HIV/AIDS
“Women living with HIV/AIDS in the community will
usually bear the responsibility for child care,
housekeeping, health and social work appointments,
and their own illness as well as the illness of their
partner, possibly children and other family members,
often their own needs are the least well met” (Berry,
Morrison, & McLachlan, 1992).
A mother will battle with her own feelings of anxiety,
depression, and sadness over her inability to truly be
a mother to her family.
Three Goals for the PA:
1.
2.
3.
Initially empower these women to care for
themselves as well as their families, by using
outside support, AIDS service agencies, and
support groups
Be with these women, hold their hands, and cry
with them as they bury a child or husband
Treat the psychological disorders such as
depression, anxiety, thoughts of suicide, bipolar
disorder, schizophrenia, and many others with
pharmaceutical agents before beginning the
treatment of HIV/AIDS because these disorders
can contribute to non-adherence
The impact of alcohol &
recreational drug use
Lifetime prevalence for alcohol use disorders (those
meeting dependence or abuse criteria) among HIV+
persons has ranged from 29% to 60% (Brown et al.,
1992; Dew et al., 1997; Kelly et al., 1998; Summers
et al., 1995).
Studies have shown that impaired judgment, shortterm memory loss, and a decline in cognitive
functioning are heightened when substances are
used (Bondi, Drake & Grand, 1998; Rosseli & Ardilla,
1996).
The impact of alcohol &
recreational drug use
The use of “club drugs”, such as methamphetamine,
ketamine, and MDMA, posit further danger for people
with HIV/AIDS, as club drugs have been shown to
lead to heightened or focused sensations, euphoria
and sexual disinhibition, depression, and cognitive
dissociation as a means of coping (Bondi, Drake &
Grand, 1998; Rosseli & Ardilla, 1996).
In particular, dehydration associated with alcohol and
amphetamine use will worsen side effect symptoms
such as diarrhea and nausea.
Review of Literature
Poor adherence contributes to the
development of drug-resistant HIV, and high
levels of medication adherence are
associated with sustained reductions in viral
load, decreased risk of developing AIDS, and
enhanced survival (Natasha et al., 2002).
Homeless persons with HIV found that all of
those who had taken 98-100% of medication
doses had an undetectable viral load
(Bangsberg et al., 2000).
Review of Literature
Recent studies have shown that very high
levels of adherence (at least 90-95% of
doses) may be needed to realize superior
treatment outcomes (Gifford et al., 2000).
Improvements in HIV medications have made
it easier for some patients to adhere to their
prescribed regimen by reducing the number
of pills that have to be taken or easing dosing
restrictions.
Review of Literature
1.
2.
3.
4.
5.
Twenty studies identified five factors that
were most often associated with nonadherence:
symptoms and medication side effects,
negative life events or stressors,
lack of family or social support,
treatment regimen complexity, and
low self-efficacy for medication taking
(Ammassari et al., 2002).
Summary/Synthesis
A consistent theme among the recommendations and
findings in their reports is the interdependent role of
cultural issues in health care and quality of care.
Cultural issues in health care were identified as
important in medical education (Cuff, 2004), in the
health care work force (Smedley, 2004; Gebbie,
2003), in health care disparities (Smedley, 2003), and
in health communications (Nielsen-Bohlman, 2004).
Summary/Synthesis
These inquiries suggest the need for core
competencies, as reflected in curricular
changes as well as new directions in
research and policy.
Women and the cultural factors related to
gender are among the issues emphasized by
policy makers, researchers, and clinicians.
Conclusion/Recommendation
Overall, “to understand and assist women living with
HIV, it is important to take a systems approach, to
look at the whole to understand the parts, to think in
loops rather than in straight line” (O’Connor, 1997).
High quality care for women living with HIV disease is
best given by addressing not only her medical needs,
but also her economic needs, her relationships, her
emotional responses, her culture, and her
community: all of the faces of a multifaceted life
(Cheever, 1999).
Thanks for Listening!!!!
Questions???
References
Ammassari, A., Trotta, M.P., Murri, R., Castelli, F., Narciso, P., Noto, P.,
Vecchiet, J., Monforte, A.D., Wu, A.W., Antinori, A., and AdICoNA Study
Group. (2002). Correlates and predictors of adherence to highly active
antiretroviral therapy: Overview of the published literature. JAIDS, 31
(Suppl 3), S123-S127.
Bangsberg, D.R., Hecht, F., Charlesbois, E., Zolopa, A., Holodniy, M.,
Sheiner, L., Bamberger, J.C.M., and Moss, A. (2000). Adherence to
protease inhibitors, HIV-1 viral load, and development of drug
resistance in an ingredient population. AIDS, 14, 357-366.
Bangsberg, D.R., Charlesbois, E.D., Grant, R.M., Holodniy, M., Deeks,
S.G., Perry, S., Conroy, K.N., Clark, R., Guzman, D., Zolopa, A., and
Moss, A. (2003). High levels of adherence do not prevent
accumulation of HIV drug resistance mutations. AIDS, 17, 1925-1932.
Barroso, P., Schlechter, M., Gupta, P., Bressan, C., Bomfim, A., and
Harrison, L. (2003). Adherence to antiretroviral therapy and
persistence of HIV RNA in semen. JAIDS, 32, 435-440.
Berry, J., Morrison, V., & McLachlan, S. (1992). Working with women
and AIDS. London: Tavistock/Rutledge.
References
Bing, E.G., Galvan, F., Burnam, M.A., Longshore, D., Orlando, M.,
Eggan, F., Fleishman, J., Caetano, R., & Shapiro, M. (2000).
Psychiatric disorders and drug and alcohol use among people with HIV
disease. Paper presented at the XIII International AIDS Conference,
Durban: South Africa.
Bondi, M.W., Drake, A.L., & Grand, L. (1998). Verbal learning and
memory in alcohol abusers and polysubstance abusers with concurrent
alcohol abuse. Journal of the International Neuropsychological Society,
4(4), 319-328.
Brown, G.R., Rundell, J.R., McManis, S.E., Kendall, S.N., Zachary, R.,
& Temoshok, L. (1992). Prevalence of psychiatric disorders in early
stages of HIV infection. Psychosomatic Medicine, 54(5), 588-601.
Center for Disease Control and Prevention. (2002). Guidelines for
using antiretroviral agents among HIV-infected adults and adolescents:
Recommendations of the Panel on clinical practices for treatment of
HIV. MMWR, 51, (RR-7), 1,64.
References
Center for Disease Control and Prevention. (2004). HIV/AIDS
Surveillance Report, 2003 (Vol. 15). Atlanta: US Department of Health
and Human Services, CDC; 1-46. Available at
http://www.cdc.gov/hiv/stats/2003surveillancereport.pdf.
Cheever, L.W., & Wu, A.W. (1999). Medication adherence among HIV
infected patients: understanding the complex behavior of taking this
complex therapy. Curr Infect Dis Rep; 1:401-407.
Chesney, M. (2000). Factors affecting adherence to antiretroviral
therapy. Clin Infect Dis, 30 (Suppl 2), S171-S176.
Chesney, M. (2003). Adherence to HAART regimens. AIDS Patient
Care STDs, 17, 169-177.
Cuff, P.A., & Vanselow, N., eds. (2004). Improving medical education:
Enhancing the behavioral and social science content of medical school
curricula. Washington, DC: The National Academies Press.
References
Dew, M.A., Becker, J.T., Sanchez, J., Caldararo, R., Lopez, O.L., Wess, J.,
Dorst, S.K., & Banks, G. (1997). Prevalence and predictors of depressive,
anxiety and substance use disorders in HIV infected and uninfected men: A
longitudinal evaluation. Psychological Medicine, 27(2), 395-409.
Evan, W., Montaner, J.S.G., Yip, B., Tyndall, M.W., Schechter, M.T.,
O’Shaughnessy, M.V., and Hogg, R.S. (2003). Adherence and plasma HIV
RNA responses to highly active antiretroviral therapy among HIV-1 infected drug
users. Can Med Assoc J, 169, 656-661.
Faltz, B.G., & Madover, S. (1986). Substance abuse as a cofactor for AIDS. In:
McKusick, L., ed. What to do about AIDS: physicians and health care
professionals discuss the issues. Los Angeles: University of California Press,
155-162.
Gebbie, K., Rosenstock, L., & Hernandez, L.M., eds. (2003). Who will keep the
public healthy? Educating public health professionals for the 21st century.
Washington, DC: The National Academies Press.
Gifford, A.L., Bormann, J.E., Shively, M.J., Wright, B.C., Richman, D.D., and
Bozzette, S.A. (2000) Predictors of self-reported adherence and plasma HIV
concentrations in patients on multi-drug antiretroviral regimens. JAIDS, 23, 286295.
References
Glynn, M., & Rhodes, P. (2005). Estimated HIV prevalence in the United States
at the end of 2003. National HIV Prevention Conference; Atlanta, Abstract 595.
Golin, C.E., Liu, H., Hays, R.D., Miller, L.G., Beck, C.K., Ickovics, J., Kaplan,
A.H., and Wenger, N.S. (2002). A prospective study of predictors of adherence
to combination antiretroviral medication. J Gen Intern Med, 17, 756-765.
Granich, R., & Mermin, J. (1999). HIV health & your community: A guide for
action. California: Stanford University Press.
Halkitis P.N., & Parsons, J.T. (in press). Recreational drug use and HIV risk
sexual behavior among men frequenting gay social venues. Journal of Gay and
Lesbian Social Services.
Halkitis, P.N., Remien, R., & Wolitski, R. (1998). Examining factors related to
adherence of antiretroviral regimens. Paper presented at the meeting of the
American Psychological Association, San Francisco, CA.
Hunter, C.E., & Ross, M.W. (1991). Determinants of health-care workers’
attitudes toward people with AIDS. Journal Appl Social Psychol, 21:947-956.
References
Ickovics, J.R., and Meade, C.S. (2002). Adherence to HAART among patients
with HIV: Breakthroughs and barriers. AIDS Care, 14, 309-318.
Internet Source #1. Basic Statistics (2003). http://www.cdc.gov/hiv/stats.htm.
Retrieved in Sept. 2005
Internet Source #2. A glance at the HIV/AIDS Epidemic (2005).
http://www.cdc.gov/hiv. Retrieved in Sept. 2005.
Katz, I., Hass, G., Parisi, N., Astone, J., McEvaddy, D., & Lucido, D.J. (1987)
Lay people’s and health care personnel’s perceptions of cancer, AIDS, cardiac,
and diabetic patients. Psychol Rep, 60:615-629.
Kelly, B., Raphael, B., Judd, F., Perdices, M., Kernutt, G., Burrows, G.D.,
Burnett, P.C., & Dunne, M. (1998). Psychiatric disorder in HIV infection.
Australian and New Zealand Journal of Psychiatry, 32(3), 441-453.
Kelly, J.A., St. Lawrence, J.S., Smith, S., Hood, H.V., & Cook, D.J. (1987).
Stigmatization of AIDS patients by physicians. Am J Public Health, 77(7):789791.
References
Lefevre, F., O’Leary, B., Moran, M., Mossar, M., Yarnold, P.R., Martin, G.J., &
Glassroth, J. (1995). Alcohol consumption among HIV-infected patients.
Journal of General Internal Medicine, 10(8), 458-460.
Maldonado, M. (1996). The challenges of HIV/AIDS for women of color and
their families. National Minority AIDS Council.
Miller, L.G., Liu, H., Hays, R.D., Golin, C.E., Beck, C.K., Asch, S.M., Ma, Y.,
Kaplan, A.H., and Wenger, N.S. (2002). How well do clinicians estimate
patients’ adherence to combination antiretroviral therapy? Gen Intern Med, 17,
1-11.
Natasha, P., Tyndall, M.W., Wood, E., Hogg, R.S., and Montaner, J.S. (2002).
Virologic and immunologic response, clinical progression, and highly active
antiretroviral therapy adherence, JAIDS, 31, S112-S117.
Nielsen-Bohlman, L., Panzer, A.M., & Kindig, D.A., eds. (2004). Health literacy:
A prescription to end confusion. Washington, DC: The National Academies
Press.
O’Connor, J., & McDermott, I. (1997). The art of systems thinking: Essential
skills for creactivity and problem solving. San Francisco: Harper Collins.
References
Petry, N.M. (1999). Alcohol use in HIV patients: What we don’t know may hurt us.
International Journal of STD & AIDS, 10, 561-570.
Rosseli, M., & Ardila, A. (1996). Cognitive effects of cocaine and polydrug abuse. Journal
of Clinical & Experimental Neuropsychology, 18(1), 122-135.
Slaby, A.E., Glicksman, A.S. (1986). Adaptation of physicians to managing life-threatening
illness. Integrated Psychiatry, 4:162-172.
Simoni, J.M., Frick, P.A., Pantalone, D.W., and Turner, B.J. (2003). Antiretroviral adherence
interventions: A review of current literature and ongoing studies. Topics HIV Med, 11, 185198.
Smedley, B.D., Butler, A.S., & Bristow, L.R., eds. (2004). In the nation’s compelling interest:
Ensuring diversity in the health care workforce. Washington, DC: The National Academies
Press.
Stone, V.E., Adelson-Mitty, J., Arnsten, J.H., Davenny, K., & Schoenbaum, E.E. (2002).
What strategies do providers use to enhance adherence to HAART? Paper presented at
the XIII International AIDS Conference, Durban: South Africa, substance use and sex.
AIDS & Public Policy Journal, 11(2), 66-77.
Summers, J., Zisook, S., Atkinson, J.H., Sciolla, A., Whitehall, W., Brown, S., Patterson, T.,
& Grant, I. (1995). Psychiatric morbidity associated with acquired immune deficiency
syndrome-related grief resolution. Journal of Nervous Mental Disorder, 183, 384-389.
Turner, B.J. (2002). Adherence to antiretroviral therapy by human immunodeficiency virusinfected patients. J Infect Dis, 185(Suppl 2), S143-S151.
Wensing, A.M., and Boucher, C.A. (2003). Worldwide transmission of drug-resistant HIV.
AIDS Rev, 5, 140-155.