European Journal of Medical Research - Deutsche AIDS ...

June 27, 2007 EUROPEAN JOURNAL OF MEDICAL RESEARCH
111
D.80 (Poster)
Risk factors for treatment denial and loss to follow
up in an antiretroviral treatment cohort in Kenya
Karcher H. 1 , Omondi A. 2 , Odera J. 2 , Kunz A. 1 , Harms G. 1
1 Institute of Tropical Medicine and International Health,
Charité-University Medicine, Berlin, Germany, 2 MoH/GTZ
PMTCT Project Migori and Kuria Districts, Migori, Kenya
Objective: The aim of the study was to evaluate risk factors
for treatment denial and loss to follow up in an antiretroviral
treatment (ART) cohort in a rural African setting in western
Kenya.
Methods: Sociodemographic and clinical data of patients enrolled
in an ART cohort were collected within 18 months of
an observational longitudinal study and analysed by logistic
and Cox regression models.
Results: Of 159 patients with treatment indication 35 (22%)
never started ART. Pregnancy (AOR 3.60, 95%CI 1.10-11.8;
p = 0.035) and lower level of education (AOR 3.80, 95%CI
1.14-12.7; p = 0.03) were independently associated with treatment
denial. The incidence of total loss of patients under therapy
was 43.2 per 100 person years (mortality rate 19.2 per
100 person years plus drop out rate 24 per 100 person years).
Higher age (AHR 1.06, 95%CI 1.01-1.12; p = 0.04), AIDS
before starting treatment (AHR 5.83, 95%CI 1.15-29.5; p =
0.03) and incomplete adherence to treatment (AHR 1.05,
95%CI 1.03-1.07; p < 0.001) were independent risk factors
for death. Incomplete adherence also independently predicted
drop out due to other reasons (AHR 1.06, 95%CI 1.04-1.09; p
< 0.001).
Conclusion: Pregnancy and lower level of education, higher
age, advanced AIDS stage and impaired compliance to ART
were identified as risk factors for treatment denial and death,
respectively. Targeting adequate counselling activities to patients
with these characteristics could help to improve adherence
and outcome of treatment programmes in resource-limited
settings.
D.81 (Vortrag)
Coinciding with medical recommendations as a
reward system?
Engelbach U. 1 , Dannecker M. 2 , Haberl A. 3 , Lenz C. 1 ,
Grabhorn R. 1
1 Klinik für Psychiatrie, Psychosomatik und
Psychotherapie/Klinikum der J.W. Goethe-Universität,
Frankfurt, Germany, 2 ehem. Institut für
Sexualwissenschaft/Klinikum der J.W. Goethe Universität,
Frankfurt, Germany, 3 HIV-CENTER - Klinikum der J.W.
Goethe-Universität, Frankfurt, Germany
This qualitative study examines the relationship between doctors
and HIV-infected patients with regard to perceived problems
of adherence to antiretroviral medication. The sample
contains 20 HIV-infected patients, who were recruited in the
HIVCenter of University/Frankfurt. The attending physicians
divided the adherent and the non-adherent patients into two
comparable groups. Doctors and patients were asked to complete
questionnaires estimating the adherence.
Psychodrama has been the method used to explore the doctor-patient
relationship (DPR) from the patient´s point of
view. The scene of a doctor-patient conversation was produced
through role reversal, videotaped, and transcribed. Ob-
jective hermeneutics was used to analyze the collected material:
four patients were chosen from the sample, being in maximum
contrast to each other with respect to ´adherence/nonadherence´
and ´role reversal possible/not possible´. The four
transcripts have been analyzed by an interpreting group at the
University/Frankfurt. Within the transcripts a structural finding
continues throughout as the single reading that cannot be
falsified: the participants are tending to involve their doctors
into their community implying the dissolution of the asymmetrical
structure of the DPR. It is strongly connected to the
confused regulation of closeness and distance, to facing the
physicians on a level of diffuse social relations, and to the
need or desire for being accepted by the doctor as somebody
particular. According to the contrast of adherent/non-adherent
patients there were differences only concerning the intensity.
Hence, for adherent behavior can be hypothesized: an individual
level of the need or desire for being accepted by the doctor
as somebody special exists within every patient. If this level is
reached, i.e. individual claims are met and personal desires
are satisfied, the patient will experience satisfaction within
the relationship and follow the physician´s advice. Several dimensions
of personality could shift this level of need or in extreme
cases be dominant enough to apparently override this
model. Thus the patient´s satisfaction with the physician
could be understood as the fulfillment of his need or desire,
the adherence as a reward for satisfied desires.
D.82 (Poster)
Effects of a nurse connection program on patients’
well-being and acceptance of Enfuvirtide-therapy
Banczyk I. 1 , Stellbrink H.-J. 2 , Wäsle B. 3 , Wagner W. 3
1 Vivantes-Auguste-Viktoria Klinik, Berlin, Germany, 2 ICH,
Hamburg, Germany, 3 Roche Pharma AG, Grenzach-Wyhlen,
Germany
Objectives: Enfuvirtide is administered subcutaneously twice
daily. The most frequent side effects are injection site reactions.1
Administration mode and ISR are main causes for interruption
and cease of therapy. Substantiated knowledge of
patient care could play an important role for successful enfuvirtide
therapy.2 The effect of nurse training on patients’
well-being and therapy acceptance are to be assessed.
Methods: A Nurse Connection Program for training and experience-exchange
has been running since February 2006,
with 5 national and 18 regional nurse trainings, so far. In parallel,
a non-interventional trial with 2 systematic questionnaires
at baseline, week 4, 12 and 24 has been conducted: 1.
Nurse experience with first therapy instruction, guidance and
estimation of patients’ satisfaction; 2. Patients quality of life.
Results: This interim analysis includes all nurse questionnaires
of patients with data at least up to week 12 (n = 45).
Baseline: nurses know their patients for 5 years on average,
51% (23) of patients feel insecure at first instruction, 56%
(25) administer the first injection on their own, first instruction
takes 40 min on average. Recommendations to reduce
ISR at baseline: 91% (41) cooling/warming of injection site,
73% (33) massage, 67% (30) antihistamine gel, 20% (9) others
(eg injection into the back, injection time up to 10 min). In
weeks 4 and 12 additional methods were recommended to reduce
ISR: shower/bath before injection, massage device, reconstitution
of enfuvirtide powder 12 hrs before application.
During treatment, the rate of patients who were at least satisfied
with their therapy was 36% (15/42) at week 4 and 51%