AEGiS-NHIVPC: HIV Prevention Case Management, an Intensive Intervetntion Targeting Those Demonstrating High Risk Behavior and Those in High Risk Groups (MSM, IDU, and Ethnic Minorities), Combines Prevention and Care Issues Into Treatment Goals and Outcomes

National HIV Prevention Conference

Atlanta, Georgia, USA — July 27 - 30, 2003

HIV Prevention Case Management, an Intensive Intervetntion Targeting Those Demonstrating High Risk Behavior and Those in High Risk Groups (MSM, IDU, and Ethnic Minorities), Combines Prevention and Care Issues Into Treatment Goals and Outcomes

Natl HIV Prev Conf 2003 July 27-30:abstract no. M1-F0702
Rollison MN; VCUHS Infectious Disease Clinic, Richmond, VA

ISSUE: Prevention Case Management (PCM), modified to an HIV-care setting, integrates prevention and healthcare.

SETTING: Infectious Disease Clinic, Virginia Commonwealth University Medical College of Virginia Hospitals, Richmond Virginia.

PROJECT: PCM, based on an intensive prevention model developed by the Centers for Disease Control, is a client-centered intervention targeting those at greatest risk for HIV/STD transmission, who have not responded to traditional prevention methods, mental health treatment, or substance abuse treatment. This program utilizes Motivational Interviewing theory and Harm Reduction concepts to identify goals and measure progress respectively for HIV+ indviduals. Comprehension of basic HIV healthcare elements, such as HIV disease process, meaning of CD4 count , viral load, and requirements for effective Antiretroviral treatment were identified as knowledge deficits during PCM participant interviews. Modified PCM not only addressed behavioral risk taking, but also provided assessment of health literacy and appropriate health education based on degree of health literacy deficits.

RESULTS: Of those who have received PCM services from 1/01 to 12/ 02 (N= 147), upon initial assessment 93% (137) demonstrated knowledge deficits related to HIV disease process, CD4 count, HIV viral load, and ARV mechanism of action. Patients who reported poor understanding of HIV health components frequently displayed high incidences of undertreated mental health and chemical addiction conditions, in addition to reporting high risk sexual behaviors. When PCM was modified to include individualized education targeting defined deficits, a comprehension-seeking, non-judgemental teaching method allowed for a non-coercive relationship to develop between PCM case manger and patient, such that behavioral high risk issues were then more easily addressed. Results from individually tailored HIV health education and increased time spent discussing prevention/transmission issues: approximately 70% of PCM (118) patients reported previously being unaware of super-infection risks, 91% (134) reported having improved understanding of the demands of effective Antiretroviral treatment and an improved conceptual understanding of medication resistance. Perhaps more dramatic, approximately 25% (N=37 ), who received PCM, achieved viral loads below the level of detection. Improved medication adherence, resulting from modified PCM , is worth noting given PCM-participants poor adherence history previously and given viremic control averages within the clinic population per provider ranging 22-49% (N=1500).

LESSONS LEARNED: Correlations may exist between poor understanding of care related issues and behavioral risk taking. Providing clear, personalized health education related to HIV-care may establish a relationship, from which behavioral issues could be better addressed. Additionally, Motivational Interviewing approach encourages patients to define their own issues, and further solicits from patients ways to resolve them. Intensive interventions afford more time to address health education deficits and develop relationships that assist patients in examining behavioral change. The application of Harm Reduction methods further allows patients to measure their own progress, define their own priorities, and identify certain health system aspects that inhibit or impede successful health and behavioral outcomes. Given PCM demographics show 95% of referred patients are Black-American, 47% men who have sex with men, and 37% women of color, this may speak to poor delivery of interventions and health education sensitive to culture, race and gender.

030727
M1-F0702