P5-S6.16 Novel modular teaching of HIV patients in resource-limiting setting: effect of learning outcomes on adherence to highly active antiretroviral therapy (HAART)

Abstract

Background: Patient education is a crucial aspect of antiretroviral treatment of HIV patients and plays a significant role in adherence to HAART, development of OIs, hospitalisation and mortality. Unfortunately, in most resource-poor setting, this is not often done, and when it is done, often casually. Objective Objective was to compare a modular teaching method (MTM) with traditional patient education (TTM), and evaluate its effectiveness on adherence to HAART, development of OIs, hospitalisation and mortality. Methods: 420 HIV-positive patients on HAART, zidovudine, lamivudine and nevirapine, were recruited and randomly divided into subject and control groups. A pre-test and post-test time-series design was used to collect data using a 30-item knowledge and skills assessment schedule with items rated on a 5-point Linkert-type scale. The schedule was pre-tested on 50 patients with Cronbach's Score of 0.92 and a test-retest co-efficient of 0.89 at a 4-week interval. The MTM consist of 10 modules which address issues on adherence such as benefits of treatment, family and social support, adverse drug effects, psychological factors, substance abuse, patientprovider relationship, patient's self efficacy and effect of traditional/ cultural values. MTM was used to educate subject group while the controls received the traditional teaching by nurses on the wards. Teaching was done throughout the period of hospitalisation. All the patients were followed for 8 months at 4-week intervals via outpatient clinic and home visits. chi2 and t-tests were used; p<0.05 was considered significant. Results: Mean age was 28.7+/-6.9 years. Mean adherence rate for the subjects was 98.9+/-1.0% and for controls, 87.+/-62.4% (p<0.001). Frequency of OIs per patient per month was lower in subjects than in controls (0.51 vs 1.31, p=0.002). Mean number of readmissions per patient per month during the 8-month follow-up was 0.1860.01 for subjects and 0.89+/-0.02 for controls (p=0.0012). Subject group had shorter hospital stay (6.2+/-2.6 days vs 15.7+/-4.8 days, p=0.002) and lower mortality (p=0.008) than the controls. Conclusion MTM has significant effect on adherence to HAART, development of OIs, readmission rate, hospital stay and mortality. MTM is recommended as a core aspect of adherence counselling and antiretroviral treatment programme.