CASE
STUDY ABSTRACT, OBJECTIVES & DESIGN
CASE
The Center for Adherence Support Evaluation
at the New York Academy of Medicine
The Potential Role of Service Delivery and Program Factors on Adherence to Highly Active Antiretroviral Therapy Outcomes: What Do Providers and Clients Have to Say?
Objectives.
HIV medication adherence support interventions are being increasingly
implemented, but there is no uniform recipe to address the difficulties
that people living with HIV/AIDS have in initiating and maintaining adherence
to HIV medication regimens. Evaluations of adherence support intervention
programs have concentrated on examining correlates of changes in adherence
at the client-level. Little is known, however, about how service-delivery
and program factors may influence clients' ability to adopt and maintain
HIV medication adherence. As part of a national multi-site evaluation
of different models of adherence support in 12 sites, we combined quantitative
and qualitative methods to investigate service delivery factors that might
influence program effectiveness for clients. In this presentation, we
focus on: (1) clients' motivations to initiate or consider taking HAART,
their facilitators and barriers to following HIV medication regimens,
and their experiences with the adherence support program; (2) clients'
and providers' perceptions of the program and its impact; and (3) organizational
facilitators and barriers to provision of adherence support services.
Methods.
Multiple data collection methods were used to accomplish these evaluation
objectives. Individual in-depth interviews were conducted with 100 health
care providers delivering adherence support services and/or HIV medical
care, and with 120 clients enrolled in adherence support interventions
in each of the 12 sites over a four-month period (March-June 2001). A
self-administered questionnaire, followed by a group interview with key
program staff was also completed. Standardized guides with focused themes
were used in both the individual and group interviews, followed by open-ended
probes to elicit further information. All interviews were tape recorded
and transcribed verbatim. Interviews were conducted by interviewers experienced
in the conduct of qualitative interviews. Data are being analyzed with
Nudist N'Vivo, a computerized software program, to identify common themes
and patterns. Inter-rater reliability of the codes developed by three
researchers was determined using the kappa coefficient.
Results.
Analyses will focus on describing the similarities and differences
between clients and providers with respect to their perceptions of intervention
successes and failures, and variations by type of program and type of
target population. Differences in program structure and implementation
style will be highlighted.
Conclusion.
Implications of program evaluation findings for clients, their adherence
support providers and medical providers, and the service delivery system
will be presented. The potential role of these factors in influencing
successful client outcomes will also be discussed.
Last updated: 4/11/02