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The University of Illinois at Chicago Howard Brown Health Center Treatment Advocacy Program

The University of Illinois at Chicago Howard Brown Health Center Treatment Advocacy Program HIV medication skills 1: Basic skills and adherence planning. Health & Well Being. HIV Medication skills for men currently on HIV treatment. Welcome to treatment coping and medication skills.

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The University of Illinois at Chicago Howard Brown Health Center Treatment Advocacy Program

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  1. The University of Illinois at Chicago Howard Brown Health Center Treatment Advocacy Program HIV medication skills 1: Basic skills and adherence planning TAP: Medication skills 1, basic skills 12/9/03 1

  2. Health & Well Being HIV Medication skills for men currently on HIV treatment Welcome to treatment coping and medication skills. Coping with Sexuality & Treatment We will start with some basic information, then we will discuss coping with treatment. TAP: Medication skills 1, basic skills 12/9/03 2

  3. Adherence Information: Basic treatment terms… Let’s begin with some basic terms… -- taking all pills on time (+ / - 2 hours..) -- following food or other restrictions -- making your medical appointments What is… Adherence? What is… Viral Load? -- amount of virus in your blood -- # copies / ml. (about 1/2 table spoon) What are… T cells? -- an important white blood cell (CD4) -- strengthens your immune system What is… Resistance? -- mutations in HIV from low adherence -- makes the virus able to fight off drugs Click here for more HIV Information TAP: Medication skills 1, basic skills 12/9/03 3

  4. Adherence Information: Importance Why is adherence important…? Over half of patients have a drug failure Median time to drug failure = 18 months Non-adherence can make HIV resistant to medications. Resistance leads to “drug failure”: • Increasing viral load • Lower CD4 count / fewer T-cells • Medications no longer effective TAP: Medication skills 1, basic skills 12/9/03 4

  5. Adherence Information: baserates Non-adherence is common in HIV • Over a third of patients miss > 20% of doses • At least half show some non-adherence • At least a quarter take partial or late doses …and in other chronic diseases Diabetes Hypertension Cardiac care… TAP: Medication skills 1, basic skills 12/9/03 5

  6. Non-Adherence: Who and Why? (1) What makes people not adhere? • Lack of Information • Ask questions!! • Difficulty talking to your provider? We will review communication skills a bit later Reaction to(often temporary)side effects • Important to speak to your provider • Nutrition or other meds may help TAP: Medication skills 1, basic skills 12/9/03 6

  7. Non-Adherence: Who and Why? (2) Why non-adherence • Depression,anger, & other moods • Social support or conflict • Avoiding / not “out” about being HIV+ • Alcohol or drug use Moods & behaviors We will review these areas next session Referral or counseling for these issues now? TAP: Medication skills 1, basic skills 12/9/03 7

  8. Non-Adherence: Who and Why? (3) Basic human memory Why non-adherence • Where did I park last night? • Repeating the same behavior makes it hard to remember each day • Yesterday’s “pill memory” interferes with remembering today’s… Thememory fullproblem • Do not rely on personal memory • Use “outside” reminders or cues TAP: Medication skills 1, basic skills 12/9/03 8

  9. Non-Adherence: Who and Why? (4) How does memory interfere with adherence…? Automatic behavior • Most day-to-day routines are “mindless” • Driving: How did I get here? • It is hard to recall / do something new • Memory of your meds can be “swept away” by your automatic routine… Use “outside” cues to… • Interrupt automatic routine • Be “mindful” TAP: Medication skills 1, basic skills 12/9/03 9

  10. Adherence Information: non-automatics • Keeping a medication schedule takes effort, skills and strategies. • We will work on skills in this section. Thus … Treatment adherence is not automatic. TAP: Medication skills 1, basic skills 12/9/03 10

  11. Continuing Safety: Super Infection Even though you are HIV+, sexual safety is still important: • You can be infected with a whole new strain of HIV • The new strain would be resistant to your current HIV drugs • It may be resistant to other drugs • Makes your HIV drugs less effective • Makes your treatment very difficult TAP: Medication skills 1, basic skills 12/9/03 11

  12. Adherence Information: Drug resistant strains Why is sexual safety still important? • Drug resistant HIV can be transmitted to others by unsafe sex Many new infections are resistant to an entire class of HIV drugs Between 10% and 30% of new infections may be resistant to > 1 class of drugs TAP: Medication skills 1, basic skills 12/9/03 12

  13. Adherence Information: Sexual Risks, 1 STDs reactivate latently infected cells: Sexual Risk Reduction is also important for your HIV care… • Causes your viral load to “spike” even if it is “undetectable” … makes your HIV harder to control. … makes you more likely to infect others. STDs are more serious in HIV+ men … more difficult to treat if you are HIV+ TAP: Medication skills 1, basic skills 12/9/03 13

  14. New STDs: Bottom line • A lot of infected men think they can’t get new STDs. In fact, … half of recent Chicago syphilis cases are HIV+ men BOTTOM LINE: A new STD can be very serious for you You can get one from unprotected sex TAP: Medication skills 1, basic skills 12/9/03 14

  15. Information: new infections • Unsafe sex • and • HIV infections are both increasing Why might this be happening? TAP: Medication skills 1, basic skills 12/9/03 15

  16. Causes of new infections? How about: • “Barebacking” culture? • General shift in gay / bi sexual norms? • How do these apply to you? HIV treatments making some men less concerned about unprotected sex? TAP: Medication skills 1, basic skills 12/9/03 16

  17. Adherence Information: Safety + Adherence = Health • Two basic HIV health formulas: Safer sex = Avoid HIV “Super-infection” Avoid STD infections + Not pass on HIV + Full Adherence = T-cells + + Viral load Resistance TAP: Medication skills 1, basic skills 12/9/03 17

  18. What is full adherence? TAP: Medication skills 1, basic skills 12/9/03 18 What is “Full” adherence to treatment?

  19. Adherence Skills: Adherence & medication effectiveness Adhering to your schedule directly affects how well medications work. 95% adherence 0 - 2 missed doses per month Full Adherence: Over 80% effective 90% adherence 2 - 3 missed doses per month About 65% effective 80% adherence 1 - 2 missed doses per week About 50% effective 70% adherence 3 - 4 missed doses per week About 25% Bottom Line: • 95% of doses • On time (+/- 2 hours) < 70% adherence 5 or more misses per week Less than 10% effective TAP: Medication skills 1, basic skills 12/9/03 19

  20. Maximum Optimal Minimum Adherence Skills:Timing of doses Taking your doses on time keeps your blood level in the optimal zone… The timing of doses is also very important. 9:00 am 9:00 pm 9:00 am 9:00 pm --------Each dose on time (9am, 9pm, 9am…); blood level stays in the zone --------Late dose (9am, 12pm, 9am ; levels get too low, then too high --------Missed dose; levels get very low, slowly recover TAP: Medication skills 1, basic skills 12/9/03 20

  21. Med. status • Let’s begin talking about how you are doing with your HIV medications right now TAP: Medication skills 1, basic skills 12/9/03 21

  22. Medication Overview Sheet What HIV medications do you take? • Pharmacy & provider contact info. phone #s, emergency #s How many doses each day? • Which pills at which times? • Time schedule that works best for you? • Food or other restrictions? What side effects or other problems are you concerned about? TAP: Medication skills 1, basic skills 12/9/03 22

  23. Adherence: Missed doses • How many visits have you missed in the past year ?(where you did not make them up..) How often do you see your HIV Doctor or health care provider?(# months) TAP: Medication skills 1, basic skills 12/9/03 23

  24. Non-HIV meds. What non-HIV medications do you take? • How long have you taken them? • How many doses each day? • How many doses have you missed in the past week? TAP: Medication skills 1, basic skills 12/9/03 24

  25. Adherence: Interruptions In the past 3 months… have you stopped any medication for a week or more? No (click one) Yes TAP: Medication skills 1, basic skills 12/9/03 25

  26. Go back to skip meds item • Advocate: please go back and click on one answer TAP: Medication skills 1, basic skills 12/9/03 26

  27. Adherence: Medication interruptions • How many times have you stopped your medications? How long have you stopped? Why did you decide to stop your med(s)? • side effects • adherence problems • physical difficulty taking meds • drug interruption with medical supervision • drug interruption without medical supervision • other: • improved health • cost / availability of meds TAP: Medication skills 1, basic skills 12/9/03 27

  28. Coping Interview, Adherence: Overall rating How often have you missed an HIV dose in the past 3 months? Two doses a day: One dose a day: 0 1 2 3 4 5 TAP: Medication skills 1, basic skills 12/9/03 28

  29. Go back to adherence scale • Advocate: please go back and click on one number from the scale TAP: Medication skills 1, basic skills 12/9/03 29

  30. 90% adherence 2 - 3 missed doses per month About 65% effective 80% adherence 1 - 2 missed doses per week About 50% effective 70% adherence 3 - 4 missed doses per week About 25% <70% adherence 5 or more misses / week Less than 10% effective 95% Adherence Let’s compare your behavior to the adherence chart 95% adherence 0 - 2 missed doses per month Full Adherence: Over 80% effective You are doing very well Work on maintaining this level Bottom Line: TAP: Medication skills 1, basic skills 12/9/03 30

  31. 95% adherence 0 - 2 missed doses per month Full Adherence: Over 80% effective 80% adherence 1 - 2 missed doses per week About 50% effective 70% adherence 3 - 4 missed doses per week About 25% < 70% adherence 5 or more misses / week Less than 10% effective 90% Adherence Let’s compare your behavior to the adherence chart 90% adherence 2 - 3 missed doses per month About 65% effective O.K. / good adherence We can get to the next level.. Bottom Line: TAP: Medication skills 1, basic skills 12/9/03 31

  32. 95% adherence 0 - 2 missed doses per month Full Adherence: Over 80% effective 90% adherence 2 - 3 missed doses per month About 65% effective 70% adherence 3 - 4 missed doses per week About 25% < 70% adherence 5 or more misses / week Less than 10% effective 80% Adherence Let’s compare your behavior to the adherence chart 80% adherence 1 - 2 missed doses per week About 50% effective Moderate adherence – some problems We need to work on getting to the next level Bottom Line: TAP: Medication skills 1, basic skills 12/9/03 32

  33. 95% adherence 0 - 2 missed doses per month Full Adherence: Over 80% effective 90% adherence 2 - 3 missed doses per month About 65% effective 80% adherence 1 - 2 missed doses per week About 50% effective About 25% effective < 70% adherence 5 or more misses / week Less than 10% effective 70% Adherence Let’s compare your behavior to the adherence chart Adherence problems Medications may not be effective at this adherence Bottom Line: 70% adherence 3 - 4 missed doses per week TAP: Medication skills 1, basic skills 12/9/03 33

  34. 95% adherence 0 - 2 missed doses per month Full Adherence: Over 80% effective 90% adherence 2 - 3 missed doses per month About 65% effective 80% adherence 1 - 2 missed doses per week About 50% effective 70% adherence 3 - 4 missed doses per week About 25% < 70% Adherence Let’s compare your behavior to the adherence chart Adherence problems Medications will not be effective at this adherence If we cannot improve adherence consider stopping meds. Bottom Line: < 70% adherence 5 or more misses / week Less than 10% effective TAP: Medication skills 1, basic skills 12/9/03 34

  35. Adherence skills • Now let’s review some skills that can help improve or maintain adherence. After this we will discuss your own personal issues about medication adherence. TAP: Medication skills 1, basic skills 12/9/03 35

  36. Adherence admonition Remember: Adherence is more difficult than it seems! • Even if you are doing well maintaining health long-term takes thought and planning • We need a specific behavioral plan. TAP: Medication skills 1, basic skills 12/9/03 36

  37. Adherence skills: overview, 1 1. Do not rely on personal memory • Basic assumptions of • adherence skills Use your environment to help memory: • Cue controls: associate doses with your ongoing daily routines • Reminders: pill box, computer warnings… (not post-it notes!). • Timers: alarm watch, palm pilot… • Make concrete, specific plans. TAP: Medication skills 1, basic skills 12/9/03 37

  38. Adherence skills: overview 2 • Track if you have taken each dose • Be a reminder 2. Track doses. Use a pill box to: • Analyze a missed / late dose: Why did I miss? What was going on? What should I change? New planning? TAP: Medication skills 1, basic skills 12/9/03 38

  39. Adherence skills: overview 3 • 3. Pre-plan for difficult doses When will it be difficult to take your meds? How can you plan for those times? What plans work best? Concrete and specific Tailored to your situation TAP: Medication skills 1, basic skills 12/9/03 39

  40. Adherence skills: overview 4 • 4. Get support from others Who has supported you in HIV? What has helped you get support? Who has been harmful? Where do you feel you might need more support? Disclosure: who can you talk to about treatment, sexuality, etc. TAP: Medication skills 1, basic skills 12/9/03 40

  41. Pill box screen • Let’s begin reviewing basic pill box skills… No Do you use a pill box? (click one): Yes TAP: Medication skills 1, basic skills 12/9/03 41

  42. Go back to pill box scale • Advocate: please go back and click on one answer TAP: Medication skills 1, basic skills 12/9/03 42

  43. No pill box • What keeps you from using one? • What made it inconvenient? • Other barriers? • What would make you more likely to use one? Have you ever tried a pill box? TAP: Medication skills 1, basic skills 12/9/03 43

  44. Pill box • How has it helped you keep track or take doses? • What has been inconvenient? • What changes would help? How has your pill box worked out? TAP: Medication skills 1, basic skills 12/9/03 44

  45. Basic Treatment Skills: The Pill Box Fill pill box • Track whether you took each dose. • Keep in sight as a reminder. Let’s review the overall pill box approach: Fill to store all your medications. Where & when can you fill it each week? Four boxes for complete monthly doses? Separate mid-day box? Where can you put it as a visible reminder? Do you need to keep it from others (children…)? TAP: Medication skills 1, basic skills 12/9/03 45

  46. Basic Treatment Skills: The Pill Box(cont.) Tracking missed doses What if you see a dose still in your pill box? • What happened to make you miss? • What could help next time: new plans? • Talk to your advocate about it at the next visit! 1. Follow the half time rule: Less than half way to next dose, take your pills. More than half way, skip. A missed dose is a learning opportunity! 2. Self monitor: TAP: Medication skills 1, basic skills 12/9/03 46

  47. Basic Treatment Skills: Personal Cue Control Plan Medication Overview Sheet Personal cue controls Timers? What can cue your morning dose? a.m. bathroom? Shaving / hair / coffee? Before breakfast? What can cue your evening ( mid-day…) dose? T.V. / Reading / internet? Dinner or p.m. Snack? Refrigerator note? Bathroom mirror? Pill box!! Visual cues? Alarm watch? Beeper? TAP: Medication skills 1, basic skills 12/9/03 47

  48. Basic Treatment Skills: Emergency Dose Keeping an “emergency” dose • In general? • At work? • While with a new sex partner? • Out for the evening / at a club? • Not sleeping at your own home? How do you carry a dose & water? Who can keep a spare dose for you? • Where? • How will you talk to them about it? TAP: Medication skills 1, basic skills 12/9/03 48

  49. Treatment Skills: Talking to your HIV care Provider • Let’s go to a new topic… • …Talking to your HIV medical provider Who do you see for HIV medical care? TAP: Medication skills 1, basic skills 12/9/03 49

  50. Treatment skills: Talking to your provider, 1 How comfortable are you talking to your HIV provider? • What questions are you able to ask? • What topics are hard to talk about? • Are you confident that you understand your treatment? • How could the medical staff better support you? TAP: Medication skills 1, basic skills 12/9/03 50

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