Medical News

New Medication Model Helps Patients Maintain Rigorous Schedule

June 25, 2003

This article is part of The Body PRO's archive. Because it contains information that may no longer be accurate, this article should only be considered a historical document.

The Institute of Human Virology has launched a national pilot program utilizing support elements like DOT (directly observed therapy) to bolster the long-term treatment success rates for those with HIV/AIDS. The program, called the JACQUES Initiative, is similar to the one successfully used to improve treatment outcomes for TB. It pairs patients with "coaches" -- medical providers, family, friends or fellow patients -- who provide support as patients embark on a rigid regimen of antiretroviral therapy.

"There's a tremendous amount of pressure on these patients to perform a task that requires much diligence ... We've tried to recognize the inherent pitfalls and develop a system that provides peer support, motivation and encouragement," said Dr. Robert Redfield, director of the clinical care and research division of IHV, a part of the University of Maryland Biotechnology Institute.

IHV treats more than 3,000 patients annually and sees firsthand the successes -- and failures -- of HIV/AIDS patients as they try to cope with the rigorous demands of their disease and their medication schedules. "Many patients do very well on therapy, yet for others it became evident that the current method provides dismal results," explained Redfield. Physicians in Baltimore, San Francisco and Cleveland have reported a more than 50 percent failure rate in less than two years. "Most see that as a failure on the part of the patient, but I believe it represents both challenges and opportunities for providers."

According to Derek Spencer, JACQUES Initiative executive director, the concept "places much greater emphasis on the inclusion of family and friends as a support element." These individuals provide the backbone of an alternative treatment delivery system that may make it easier for an HIV/AIDS patient to adhere to their drug schedule -- simply by reinforcement, gentle reminders and words of encouragement.

AIDS clinicians acknowledge the marked advances for treatment present challenges for the patients -- numerous prescriptions are taken multiple times each day and at very precise times. "We must design clinical systems that match the standards and treatment outcomes we desire for our patients," added Spencer. "If we want our patients to take their medicine excellently, we must function at that same level of excellence."

Meanwhile, Redfield remains positive that the results from the initiative, which also incorporates monthly workshops for HIV patients and their families, will translate to better health for the patients he sees daily. "We know that with the current treatment approach, we need a 99 percent adherence rate to be effective. I'm convinced that if we let you do this on your own, no matter how good you are, a majority of patients will fail, but it doesn't have to be that way," Redfield said.

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Adapted from:
AIDS Weekly

This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.


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