chapter  4
I Just Don’t Feel Like Taking Them: Adherence Counseling and Medical Case Management
Pages 15

This chapter describes an adherence project where health care providers worked collaboratively to develop protocols for intake, medication education, ongoing assessment, and summaries of client outcomes. Part of the impetus for the “Adherence Project,” as I refer to it, was federal guidelines for Ryan White that were beginning to redefi ne case management from a social support to medical model. Several agencies provided supportive counseling, but did not have anyone with a background in adherence counseling. Further, no one was collecting any data on adherence; this project was initiated in order to establish an ongoing evaluation plan for tracking client outcomes and providing for continuous quality improvement. At the time the project was funded in 2002, there was already a great deal of discussion of the CAREWARE data management program required by HRSA. There was broad-based interest in tracking client-level outcomes in order to evaluate HIV care, including medications received and compliance; referrals to both mental health and substance abuse providers, and the ability of these referrals to improve medical outcomes; and interest in the role of clients’ (HIV-positive individuals in treatment) own knowledge and behaviors in improving client-level outcomes. In short, adherence was a key research problem defi ned and driven by the community of HIV providers, rather than academic research that characterizes the majority of the research on HIV treatment adherence.