AFISE CEAT – an Adherence Measurement Tool

Adherence, Sexual Education, Stigma & Discrimination CEAT – an Adherence Measurement Tool for Clinical Use Issues Psychologists at the Center of Excellence (COE) have adopted a tool called CEAT (questionnaire to evaluate adherence to HIV therapy), which has been used in direct work with patients with HIV. Psychologists are constantly trying to find new ways of working with patients with HIV, particu- larly for increasing adherence to antiretroviral therapy (ART). This tool is adapted to the individual needs of the patient. It has been used in clinical practice at the Constanta COE for the past 3 years, and it has provided support in the establishment of specific interventions. Description CEAT contains 18 items, and it is designed to identify the following: beliefs about medications and their effectiveness; subjective norms (behavior, expectations, support from peer/significant others); self-efficacy – the extent to which the patient trusts he/she can successfully practice appropri- ate and healthy behaviors; other barriers (external factors – distance, financial issues, etc.). The CEAT-VIH was translated and adapted after “Cues- tionario para la Evaluacion de la Adhesion al Tratamiento Antirretroviral en Personas con Infeccion por VIH y SIDA” original, Remor, 2001a, 2002b, 2008. We use this type of questionnaire to investigate the relationship between self-reported adherence and psychological barriers. In addition, we establish specific interventions adapted to the individual needs of the patient. For the answers, a Likert-type scale was used. Only the last question required that the patient answer how many days he didn`t take his pills. This instrument has a specific interpretation and scoring guideline, and it provides a profile automatically after entering data in the scoring table. After obtaining the patient’s profile, the psychologist establishes which interventions are best for each respective patient. Here is an example of CEAT questionnaire being used: Items of the CEAT 1. Have you ever stopped taking your pills? 2. If you felt better, did you ever skip taking your pills? 3. If you felt worse after taking the pills, did you ever skip taking your pills? 4. If you feel sad or depressed, did you ever skip taking your pills? 5. How do you get along with your doctor? 6. How difficult it is for you to take the pills? 7. How much do you feel you know about the pills? 8. How much do you think the pills help you? 9. How much do you think your health status has im- proved since you started taking pills? 10. How confident are you that you can take the pills? 11. Usually, you take your pills at the correct time? 12. When your test results are good, does the doctor en- courage you to keep taking your pills? 13. How do you feel in general since you began taking your pills? 14. How bad do you feel after you take your pills? 15. How much time do you think you need to spend taking your pills? 16. How conscientious, you think you are about taking your pills? 17. How difficult it is for you to take your pills? 18. Since you have been under treatment, have you hap- pened to not take pills all day / or for more than one day? The patient is a young female, 26 years old with history of non-adherence, without kids, who was diagnosed in 1997. We decided to identify barriers to ART. The CEAT questionnaire was applied, and the barriers that the young woman faced were identified. Using the results from the CEAT ques- tionnaire, a psychotherapeutic intervention one-on-one psychotherapeutic intervention was considered to be appropriate as well as also participat- ing in group therapy. The young woman attended the counseling sessions for 6 months with about 2 sessions per month. At the end of the counsel- ing sessions the CEAT questionnaire was once again re-administered, and a significant reduction of the initially identified barriers was found. Also, new functional beliefs had been formed. The first results of the CEAT questionnaire shows that the young female has an average score of the adherence to ART of 71%. Using this result, the psychologist made an intervention plan specific for this patient. The most frequent barriers identified were: perception of immediate side effects, perception of personal costs related to the time required adherence, global assessment, perception of personal costs related to the time required for adherence, treatment omission. Barriers to adherence Barriers to adherence – Adherent behavior – – perception of imme- perception of personal global assessment diate side effects costs related to the time required adherence From the medi- cal point of view – interventions From the psy- chosocial point of view – interventions Home visits to moni- Advice on maintaining tor adherence to: adherence to ARV ther- ARVT, TB treatment, apy gynecologic check-ups Barriers to adherence – perception of personal costs related to the time re- quired for adherence Adherence behavior – treatment omission Referral for evaluation to an infectious diseases spe- cialist and a pulmonolo- gist She wishes to change her physician. The young female, argued that another reason that caused her to reach treatment failure was the improper relationship between her and her doctor. Presently, the doctor - patient relationship it’s functional The patient was accompanied to various medical offices in order to complete the recommended medical approaches. This has made possible to establish an efficient relationships between beneficiary-psy- chologist. Information regarding their legal rights. After many years since diag- nosis, the young female has decided to submit the documents in order to ob- tain her legal rights, she was assisted in doing that Identifying beliefs about treatment, its management, long-term positive effects; Family counseling to identify the resource that can suppor