The HAART Protocol has been designed to ensure that all patients receive education about HAART and the importance of adherence for therapeutic success. In addition, the patient’s readiness to begin antiretrovirals is assessed as well as identification and elimination of potential barriers to adherence prior to initiation of HAART.
All patients who are initiating a new HAART regimen are required to go through the HAART Protocol except for:
- Patients who have been off HAART for < 6 months
- Patients with neurologic complications of HIV (e.g., PML, HIV dementia, etc.) where HAART is urgent.
- Pregnancy – all pregnant patients should be referred to Jane Hitti or Sharon Martens.
- Patients with severe ITP.If patients have one of the following conditions listed above, they will receive medications on the day of the appointment and basic drug information from pharmacy. Nursing will schedule their appointments with each discipline to take place in the following weeks.
In addition to referring the patient to the HAART protocol, one can refer the patient to the “on-HAART” protocol. It should be noted that the HAART Protocol is required to begin antiretrovirals at Madison Clinic, and the On-HAART Protocol is recommended for the appropriate patients.
Step 1: REFER PATIENTS TO THE HAART PROTOCOL AS APPROPRIATE:
- Patients required to be enrolled in HAART Protocol before starting HAART
- Patients naïve to HAART therapy (may have received nucleosides in the past)
- Patients who have been off HAART for > 6 months
- Patients eligible to be enrolled in On-HAART Protocol
- Patients on HAART considering a change due to intolerance or virologic failure
- Patients on HAART who have been identified as having adherence problems
- Patients already started on HAART (from other providers or primary infection clinic) who desire education about the regimen
- Patients off HAART for < 6 months who are considering restarting therapy
- Any patients not meeting the above criteria who wishes to learn more about antiretrovirals through interdisciplinary education.
Note: When referring a patient to the On-HAART Protocol, on the top of the HAART Form, cross out “Pre” and write “On” HAART. You can specify which disciplines you would like your patients to see for more in-depth education.
Step 2: COMPLETE THE HAART FORM:
- The HAART forms can be found in the standing file folders in each exam room and in the provider room. Providers should write as much information as possible concerning the patient’s antiretroviral history (including what medications were tried, duration on each med, any side effects or resistance with particular meds) – This will enable pharmacy to better evaluate and promote the next ARV regimen to the patient.
- Provide any relevant adherence information (i.e. homelessness, drug use, prior nonadherence, etc.)
- Suggest a regimen that you are considering starting the patient on. If you would like pharmacy to assist with narrowing down the regimen choices, you can suggest a few regimens and pharmacy will discuss all of the pros and cons with the patient and determine what regimen would work best for them. Having pharmacy discuss medication options can save you time during your clinic visit and you can still feel comfortable because you know all of the information is being covered. None of the other disciplines will ever undermine a provider’s suggestion or the patient’s trust in their provider, but we may suggest alternatives as appropriate and discuss them with the provider when possible. All comments are written on the HAART Protocol routing slip and notes on ORCA/Mindscape, so it is important to read them every time.