Transcript Powerpoint - International AIDS Society

Vancouver, British Columbia, Canada
Kathleen Deering, Kate Shannon,
Hayley Sinclair, Devi Parsad,
Erin Gilbert, Mark Tyndall
1) University of British Columbia
School of Population and Public Health
2) British Columbia Centre for Excellence in
HIV/AIDS
3) WISH Drop-In Centre Society
 The
MAKA Project
• Participatory-research project aimed at
exploring the harms and barriers faced by
women sex workers living with HIV/AIDS
 Peer-driven
intervention (PDI)
• Aim: enhance the uptake and sustainability of
antiretroviral therapy (ARV) among women sex
workers in Vancouver
Drop-in nursing
service
Weekly peersupport
meetings
-HIV and nutrition
-drug use/ARV interactions
-managing side effects
-budget planning
-emotional/mental health &
grief/loss
Broadhead et al, 2002/ Social
Science & Medicine
Peer-driven
intervention
Peer
outreach
service
-peer outreach workers
provide lunches, safe
sex materials to nonPDI sex workers
Health advocate
(buddy) system
 Objective: Determine
adherence outcomes

1. Self-report

2. Pharmacy data
the impact of the PDI on
• Weekly questionnaire by peers/ health advocates
• 3-monthly nursing questionnaire by nurse (& blood work)
• Project nurse collected information directly from pharmacies
regarding ARV pick-up/adherence

3. Viral load

4. Qualitative in-depth interviews
• Provincial Drug Treatment Program
• Independent process evaluation of women’s experiences at
baseline and one-year
 Outcomes
 Self-report:
 Fraction of weeks with 100% adherence
 i.e. “Did you take all of your ARVs this week?”
 Pharmacy records:
 Fraction of days adherent to ARVs per PDI-week
 Viral load
 Fraction of tests <=50 or <= 400 copies/mL
 Factors
 Exposure to program (number of PDI meetings
attended; beginning/end; pre-PDI/during-PDI)
 Drug use, housing instability, self-rated health (n/s)
N=20
Mean/Frequency
Num. PDI meetings attended
50 [21 – 70]
Age (years)
41 [21 – 62]
Gender
Female
Trans
90% (18)
10% (2)
HCV
Nausea or vomiting
Diarrhea
Abdominal pain
Neuropathy
Rash
Headache
Asthma
Depression
75% (15)
30% (6)
15% (3)
25% (5)
30% (6)
35% (7)
25% (5)
30% (6)
50% (10)
 Overall: 91.7%
 No
clear trend with number of PDI meetings
attended
 First 13 compared with last 13 meetings
•
•
•
•
•
•
First 13: 87.4%
Last 13: 90.4%
Average increase of 3.7%
11 reported increase (average increase: 17.8%)
4 reported no change
5 reported decrease (average decrease: 19.1%)
 Overall
mean adherence per-PDI week: 87.9%
 Fraction weeks 100% adherence: 75.8%
 lower than self-reported adherence
 Fraction
weeks >=80% adherence: 83.2%
 No apparent relationship with number of PDI
meetings attended

Appeared to be positive relationship between
pharmacy adherence and self-reported adherence



Fraction of tests with viral load <=50 c/mL increased by
39% over time
Fraction of tests with viral load<=400 c/mL increased by
40% over time
Over time: one year prior to PDI vs. period enrolled in PDI
 Pre-PDI

to PDI period
Mean percent change in fraction of tests <=50 c/mL
increased as frequency of meetings attended increased

General
• Small sample size
• No comparison group
• Population characteristics (health problems, drug use)

Self-report
• Social desirability bias

Pharmacy data
• High amount of missing/unconfirmed data
 Time-consuming to collect
 Non-centralized pharmacies

Viral load (and self-report)
• Connection to adherence
 Positive
impact of PDI on adherence outcomes
 Other impacts of PDI on HIV care
• Drew attention to HIV/AIDS treatment needs of a
marginalized population
• Qualitative interviews:
 Increased self-esteem, self-efficacy
 Reduced drug use, sex work
 Future
steps





All the women who provided their time and expertise
Maka Project research team: Rose, Laura, Sandy,
Katherine Chan, Laura Housden, Nabeela Khan
Community Partner, WISH Drop-In Centre Society,
and collaborators: PACE, PEERS, Vancouver Native
Health, MAT DOT program
Rest of the Investigator Team: Kate Gibson, Thomas
Kerr, Evan Wood, Anita Palepu, Natasha Press, Cindy
Patton, Treena Orchard
Canadian Institutes of Health Research