Project Lead(s): Megan Coffee
Disruptive factors – whether social or environmental – prevent the daily administration of medications for patients on HIV treatment and tuberculosis DOTS (Directly Observed Treatment, Short Course).
In Haiti, after the 2010 earthquake, housing was disrupted for many patients who had to live in tents and temporary housing, and/or were forced to move every few days or weeks.
In such an environment, relying on community workers to track and deliver medications daily was not a feasible strategy.
The Ti Kay Haiti Tuberculosis Adherence Program provides resources to assist patients when disruptions may interrupt treatment.
The Patient Adherence System used an innovative, peer-based approach to supporting patients struggling to take their daily medications, by having ex-patients call new patients to check in and discuss concerns. This peer influence, buttressed by the work of trained counselors, ensures patients are taking their medications properly.
The tracking of patient appointments is done through a database created by Ti Kay volunteers. This database is able to quickly generate lists of patients who have missed appointments, and provide the list to patient callers or role models. When these patients cannot be reached over the telephone or do not come for an appointment, outreach counselors are used.
Results showed the feasibility of using peer support to enhance treatment adherence in internally displaced TB patients.
Forty patients were enrolled in the program as callers to provide peer support.
Peer support of treatment adherence resulted in 85% of patients in the study being on schedule to complete their TB medication regimen (643 patients completed TB treatment on time), despite these patients being the most critically ill patients living under highly disrupted conditions.
The final tally of patients who completed treatment could not be determined during the study because of the long time-period required to complete the TB treatment regimen.
In the future, Ti Kay hopes to find an alternative location to create an inpatient care facility.