The role of SEAD project intervention in viral suppression of HIV/AIDS patients with follow-up and adherence barriers

Purpose of study: Irregular FUP/ADH were associated with virologic failure [1] leading to an increase in mortality [2]. 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. Univariate and multivariable models were performed to evaluate the influence of SEAD intervention in virological suppression (HIV-ARN 90% 29.3%; median CD4 cell count 333 [164-536] cells/mL and HIV-RNA 50% of planned interventions. After a median follow-up of 3.9 (3.27-4.43) years 218 patients received 8 (3-12) interventions/year, 95% evaluation interview and 30% psychological counselling (3 sessions/year [2-5]). Virological suppression was achieved by 67% of patients. In logistic regression analysis an intervention higher than 50% of planned HR 0.44 (95% CI 0.20-0.97) and receiving psychological counselling HR 0.220 (95% CI 0.112-0.44) were independent predictors of virological suppression whereas alcohol 3.11 (95% CI 1.24-7.80) and severe biopsychosocial problems HR 2.39 (95% CI 1.134-5.040) were associated with worse virological response, after adjusting for age, alcohol or cocaine abuse, degree of adherence, baseline virological suppression, median follow-up, intravenous acquisition of HIV, and family support. Conclusions: General and psychological SEAD intervention resulted in higher virological suppression in patients with severe follow-up and adherence barriers. (Published: 11 November 2012) Citation: Abstracts of the Eleventh International Congress on Drug Therapy in HIV Infection Elias Casado L et al. Journal of the International AIDS Society 2012, 15 (Suppl 4):18093 http://www.jiasociety.org/index.php/jias/article/view/18093 | http://dx.doi.org/10.7448/IAS.15.6.18093