LEVEL 4 LEVEL 3 LEVEL 2 LEVEL 1 Areas of Functioning (4 points) (3 points) (2 points) (1 point) Details the Client’s current and historical adherence to both medical care and ARV regimens; assesses any TREATMENT physical, environmental, and/or emotional factors that may directly impact the Client’s ability to maintain treatment adherence; and determines the level of support the Client may need to achieve ADHERENCE recommended levels of treatment adherence. Client is adherent to Client reports missing Client reports missing Client is adherent to ARV doses of scheduled doses of scheduled medication regimen and MEDICATION ADHERENCE ARV medication regimen medication daily and is medication weekly and is has a viral load of less but may need occasional experiencing on-going experiencing on-going than 400; assistance from MCM to barriers to adherence and barriers to adherence OR maintain optimum has a viral load of more and has a load of Reports missing no more adherence. than 400; more than 400; than one (1) dose in a 30 OR OR day period; Client refuses to follow Client reports choosing to OR prescribed ARV engage in ARV medication is not medication regimen and alternative/herbal drug indicated at this time. has a viral load of more and is medically stable; than 400; OR OR Client just starting on ARV Client chooses medication regimen; herbal/alternative drug OR therapies despite negative Client’s long-term health outcomes; ARV medication regimen OR is does not appear to be Client requires effective. professional assistance to take medication. OR Client is diagnosed, and not yet prescribed or taking medications Score:
Areas of Functioning LEVEL 4 (4 points) LEVEL 3 (3 points) LEVEL 2 (2 points) LEVEL 1 (1 point) TREATMENT ADHERENCE Details the Client’s current and historical adherence to both medical care and ARV regimens; assesses any physical, environmental, and/or emotional factors that may directly impact the Client’s ability to maintain treatment adherence; and determines the level of support the Client may need to achieve levels of treatment adherence. MEDICATION ADHERENCE Score: Client reports missing doses of scheduled medication daily and is experiencing on-going barriers to adherence and has a viral load of more than 400; OR Client refuses to follow prescribed ARV medication regimen and has a viral load of more than 400; OR Client chooses herbal/alternative drug therapies despite negative health outcomes; OR Client requires professional assistance to take medication. OR Client is diagnosed, and not yet prescribed or taking medications Client reports missing doses of scheduled medication weekly and is experiencing on-going barriers to adherence and has a load of more than 400; OR Client reports choosing to engage in alternative/herbal drug and is medically stable; OR Client just starting on ARV medication regimen; OR Client’s long-term ARV medication regimen is does not appear to be effective. Client is adherent to ARV medication regimen but may need occasional assistance from MCM to maintain optimum adherence. Client is adherent to ARV medication regimen and has a viral load of less than 400; OR Reports missing no more than one (1) dose in a 30 day period; OR ARV medication is not indicated at this time. recommended
ELECTRONIC_Standardized_Michigan_HIV_MCM_Acuity_Pilot_Tool_2.2016_517969_7.docx