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1 Maintaining counselling nurses for HIV patients treated by HAART at Nice University Hospital (France) : theory versus practice L.Bentz, M.Morin, C.Tourette-Turgis, M.Rbillon, P.Dellamonica, J.G.Fuzibet, J.P. Cassuto, J.P.Moatti, C.Pradier 13th international Conference on Health Promoting Hospitals (HPH) Dublin May 18-20th, 2005

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2 Background In 1998, effectiveness of HAART on mortality In 1999 at Nice University Hospital, 2500 HIV infected patients followed yearly in 3 main departments

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3 New problems concerning treatment adherence Idea of an intervention-research program, including counselling by professionals

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4 Background (2) Principles of HIV counselling aiming at treatment adherence An operational definition of adherence addressing the 4 components affecting adherence A patient-centred intervention Empathic approach based on active listening as well as acceptance of diversity of life styles Active intervention

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5 MOTHIV model : concept and strategies Voluntary nurses An intensive training for nurses, follow up and supervision. A structured and brief counselling intervention (4 x 45 mn sessions) Nurses tools : interview script and adherence assessment sheet

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7 MOTHIV : tool samples Intervention script N1

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8 Tool samples Adherence assesment sheet

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9 Background (3) The program was launched in June 1999 On-going from 1999 to 2005 Assessment of impact Assessment of activity

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10 Results Randomized study 310 patients offered participation 246 patients included (79%) intervention group (IG) n=124 control group (CG) n=122 1 death 123 patients (IG)121 patients (CG) 8 lost to follow-up 2 deaths 7 lost to follow-up 2 deaths 112 patients (CG) M0 M6 M24 113 patients (IG)

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11 Results At M0 comparable patients in IG and CG : Age Gender Mode of transmission Education level CDC stage VL / CD4 HAART Average duration of HAART % of treatment change

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12 Results Assessment M0/M6 Positive impact of counselling consultations on : adherence and VL at 6 months Pradier, Bentz et al, HIV Clinical Trials, 2003, 4, 121-131

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13 Results Assessment M0/M24

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14 Results Assessment M0/M24 Comparison of the average differences in VL (M0/M24) -0,22 -0,47 0,12 -0,07 -0,12 -0,36 Deltas VL (log cp/ml) IGCG M6 M12 M18M24 p=0,013p=0,027 p=0,002 p