1
|
Ahmed A, Dujaili JA, Chuah LH, Hashmi FK, Le LKD, Chatha ZF, Khanal S, Awaisu A, Chaiyakunapruk N. Cost-Effectiveness Analysis of Pharmacist Adherence Interventions in People Living with HIV/AIDS in Pakistan. Healthcare (Basel) 2023; 11:2453. [PMID: 37685487 PMCID: PMC10487586 DOI: 10.3390/healthcare11172453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/27/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
Background: Evidence has shown the positive impact of pharmacist involvement on the adherence and health outcomes of people living with HIV/AIDS. However, whether such intervention provides value for money remains unclear. This study aims to fill this gap by assessing the cost-effectiveness of pharmacist interventions in HIV care in Pakistan. Methods: A Markov decision analytic model was constructed, considering clinical inputs, utility data, and cost data obtained from a randomized controlled trial and an HIV cohort of Pakistani origin. The analysis was conducted from a healthcare perspective, and the incremental cost-effectiveness ratio (ICER) was calculated and presented for the year 2023. Additionally, a series of sensitivity analyses were performed to assess the robustness of the results. Results: Pharmacist intervention resulted in higher quality-adjusted life years (4.05 vs. 2.93) and likewise higher annual intervention costs than usual care (1979 USD vs. 429 USD) (532,894 PKR vs. 115,518 PKR). This yielded the ICER of 1383 USD/quality-adjusted life years (QALY) (372,406 PKR/QALY), which is well below the willingness-to-pay threshold of 1658 USD (446,456 PKR/QALY) recommended by the World Health Organization Choosing Interventions that are Cost-Effective. Probabilistic sensitivity analysis reported that more than 68% of iterations were below the lower limit of threshold. Sensitivity analysis reported intervention cost is the most important parameter influencing the ICER the most. Conclusion: The study suggests that involving pharmacists in HIV care could be a cost-effective approach. These findings could help shape healthcare policies and plans, possibly making pharmacist interventions a regular part of care for people with HIV in Pakistan.
Collapse
Affiliation(s)
- Ali Ahmed
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya 47500, Selangor, Malaysia
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad 44000, Pakistan
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya 47500, Selangor, Malaysia
- Swansea University Medical School, Singleton Campus, Swansea University, Wales SA1 8EN, UK
| | - Lay Hong Chuah
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya 47500, Selangor, Malaysia
| | - Furqan Khurshid Hashmi
- Punjab University College of Pharmacy, University of Punjab, Allama Iqbal Campus, Lahore 54000, Pakistan
| | - Long Khanh Dao Le
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Zeenat Fatima Chatha
- Department of Community Medicine and Global Health, University of Oslo, 0318 Oslo, Norway
| | - Saval Khanal
- Health Economics Consulting, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Ahmed Awaisu
- Department of Clinical Pharmacy & Practice, College of Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
| | - Nathorn Chaiyakunapruk
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT 84108, USA
| |
Collapse
|
2
|
Sued O, Cecchini D, Rolón MJ, Calanni L, David D, Lupo S, Cahn P, Cassetti I, Weiss SM, Alcaide ML, Rodriguez VJ, Mantero A, Jones DL. A small cluster randomised clinical trial to improve health outcomes among Argentine patients disengaged from HIV care. LANCET REGIONAL HEALTH. AMERICAS 2022; 13:100307. [PMID: 36210799 PMCID: PMC9536254 DOI: 10.1016/j.lana.2022.100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Patients disengaged from HIV care, e.g., missed medication pick-ups, not attending physician visits, account for ≥70% of new HIV infections. Re-engaging and sustaining engagement is essential to controlling the HIV pandemic. This study tested a physician-delivered evidence-based intervention, Motivational Interviewing (MI), to improve health outcomes, adherence to antiretroviral therapy (ART), HIV virologic suppression, CD4+ count, retention in HIV care, and self-efficacy among patients disengaged from care in Argentina. Methods Regional clinics (n = 6) were randomised to condition, MI Intervention or Enhanced Standard of Care (ESOC), and recruited N = 360 patients disengaged from HIV care. ART adherence, HIV RNA viral load, CD4+ count retention, and self-efficacy were assessed at baseline, 6, 12, 18, and 24-months. Indirect effects from condition to main outcomes were examined using patient-provider relationship as a mediator. The study was a cluster-randomised clinical trial entitled Conexiones y Opciones Positivas en la Argentina 2 (COPA2) and was registered at clinicaltrials.gov, NCT02846350. Findings Participants were an average age of 39·15 (SD = 10·96), 51% were women; intervention participants were older (p = ·019), and more ESOC participants were women (60% vs. 42%, p = 0·001). Using mixed models, the intervention had no effect on ART adherence over time by condition on HIV RNA viral load, CD4+ count retention, or self-efficacy. However, analysing mediated paths, there was an indirect effect of condition on ART adherence (B = 0·188, p = 0·009), HIV viral load (B = -0·095, P = 0·027), and self-efficacy (B = 0·063, P = 0·001), suggesting the intervention was associated with improved patient-provider relationships, which was in turn associated with increased ART adherence, lower HIV viral load, and higher self-efficacy. Interpretation These findings suggest that physician-delivered MI may enhance the patient-provider relationship, self-efficacy, and ART adherence, and reduced HIV viral load in patients disengaged from HIV care. However, these findings are preliminary due to the small number of clusters randomised, and replication is warranted. Funding National Institutes of Health.
Collapse
Affiliation(s)
- Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | - Diego Cecchini
- Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina
- Helios Salud, Buenos Aires, Argentina
| | - María José Rolón
- Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires, Argentina
| | | | | | - Sergio Lupo
- Instituto Centralizado de Asistencia e Investigación Clínica Integral (CAICI), Rosario, Argentina
| | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | | | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria Luisa Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Alejandro Mantero
- Department of Public Health Sciences, Division of Biostatistics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
3
|
Ahmed A, Dujaili JA, Jabeen M, Umair MM, Chuah LH, Hashmi FK, Awaisu A, Chaiyakunapruk N. Barriers and Enablers for Adherence to Antiretroviral Therapy Among People Living With HIV/AIDS in the Era of COVID-19: A Qualitative Study From Pakistan. Front Pharmacol 2022; 12:807446. [PMID: 35153763 PMCID: PMC8832364 DOI: 10.3389/fphar.2021.807446] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/20/2021] [Indexed: 01/30/2023] Open
Abstract
Background: With the increased availability of safe antiretroviral therapy (ART) in recent years, achieving optimal adherence and patient retention is becoming the biggest challenge for people living with HIV (PLWH). Care retention is influenced by several socioeconomic, socio-cultural, and government policies during the COVID-19 pandemic. Therefore, we aim to explore barriers and facilitators to adherence to ART among PLWH in Pakistan in general and COVID-19 pandemic related in particular. Methods: Semi-structured interviews were conducted among 25 PLWH from December 2020 to April 2021 in the local language (Urdu) at the ART centre of Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Interviews were audio-recorded in the local Urdu language, and bilingual expert (English, Urdu) transcribed verbatim, coded for themes and sub-themes, and analyzed using a phenomenological approach for thematic content analysis. Results: Stigma and discrimination, fear of HIV disclosure, economic constraints, forgetfulness, religion (Ramadan, spiritual healing), adverse drug reactions, lack of social support, alternative therapies, and COVID-19-related lock-down and fear of lesser COVID-19 care due to HIV associated stigma were identified as barriers affecting the retention in HIV care. At the same time, positive social support, family responsibilities, use of reminders, the beneficial impact of ART, and initiation of telephone consultations, courier delivery, and long-term delivery of antiretrovirals during COVID-19 were identified as facilitators of HIV retention. Conclusion: Improving adherence and retention is even more challenging due to COVID-19; therefore, it requires the integration of enhanced access to treatment with improved employment and social support. HIV care providers must understand these reported factors comprehensively and treat patients accordingly to ensure the continuum of HIV care. A coordinated approach including different stakeholders is required to facilitate patient retention in HIV care and consequently improve the clinical outcomes of PLWH.
Collapse
Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Department of Pharmacy, Quaid-I-Azam University, Islamabad, Pakistan
- *Correspondence: Ali Ahmed, ; Juman Abdulelah Dujaili, ; Ahmed Awaisu,
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- *Correspondence: Ali Ahmed, ; Juman Abdulelah Dujaili, ; Ahmed Awaisu,
| | - Musarat Jabeen
- ART Centre, Pakistan Institute of Medical Sciences (PIMS) Hospital, Islamabad, Pakistan
| | - Malik Muhammad Umair
- National AIDS Control Programme, National Institute of Health, Islamabad, Pakistan
| | - Lay-Hong Chuah
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
| | - Furqan Khurshid Hashmi
- University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, Pakistan
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
- *Correspondence: Ali Ahmed, ; Juman Abdulelah Dujaili, ; Ahmed Awaisu,
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| |
Collapse
|
4
|
Rodriguez VJ, Abbamonte JM, Alcaide ML, Rodriguez Yanes NL, de la Rosa A, Sued O, Cecchini D, Weiss SM, Jones DL. Motivational Interviewing Training for HIV Care Physicians in Argentina: Uptake and Sustainability of an Effective Behavior Change Intervention. AIDS Behav 2021; 25:1675-1687. [PMID: 33245445 DOI: 10.1007/s10461-020-03083-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
Motivational interviewing (MI) utilizes a patient-centered approach to address patient ambivalence about treatment and has been found to improve treatment ART adherence among patients living with HIV disengaged from care. This study examined MI training for clinicians, uptake, and sustainability over time. Clinics (n = 7) with N = 38 physicians were randomized to condition (MI, Enhanced Standard of Care). Physicians completed video- recorded patient consultations at baseline and 6, 12, and 18-month follow-up. MI condition physicians had greater relational and technical scores over time and were more likely to adhere to and sustain MI over time. Overall, physicians found the MI training highly acceptable and were able to sustain their skills. Results illustrate the feasibility of MI training, implementation, and sustainment over 18 months. Findings support previous research in Argentina in which trained physicians found MI useful with challenging patients. Broader implementation of MI among HIV care physicians in Argentina is merited.
Collapse
Affiliation(s)
- Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404A, 1400 NW 10th Avenue, Miami, FL, 33136, USA
- Department of Psychology, University of Georgia, Athens, USA
| | - John M Abbamonte
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404A, 1400 NW 10th Avenue, Miami, FL, 33136, USA
| | - Maria Luisa Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Nicolle L Rodriguez Yanes
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404A, 1400 NW 10th Avenue, Miami, FL, 33136, USA
| | - Aileen de la Rosa
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404A, 1400 NW 10th Avenue, Miami, FL, 33136, USA
| | - Omar Sued
- Fundación Huésped, Pasaje Angel Peluffo 3932, C1202ABB, Buenos Aires, Argentina
| | | | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404A, 1400 NW 10th Avenue, Miami, FL, 33136, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404A, 1400 NW 10th Avenue, Miami, FL, 33136, USA.
| |
Collapse
|
5
|
Sued O, Cecchini D, Abbamonte JM, Rodriguez VJ, Mandell LN, Cristofari NV, Figueroa MI, Cassetti I, Cahn P, Weiss SM, Alcaide ML, Cahn F, Calanni L, Crinejo A, David D, Lupo S, Pérez C, Pérez R, Rodriguez C, Rolón MJ, Sisto A, Trapé L, Jones DL. Cumulative Burden of Mental Health Factors and Engagement in HIV Care in Argentina. Int J Behav Med 2021; 28:318-327. [PMID: 32725586 DOI: 10.1007/s12529-020-09921-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cumulative burden of multiple mental health conditions may worsen physical health outcomes in vulnerable populations. Accordingly, identifying cumulative burdens of mental health conditions that may affect HIV treatment and care can guide public health strategies to reduce their impact on HIV-related health outcomes. This study examined the relationship between the cumulative burden of mental health conditions and factors associated with engagement in HIV care in Argentina. METHOD Data for this study was obtained at baseline from Conexiones y Opciones Positivas en la Argentina 2 (COPA2). Participants (N = 360) were cisgender patients living with HIV who were lost to care, recruited from seven clinics serving people living with HIV in four Argentine urban centers. Cumulative burden of mental health conditions (i.e., depressive symptoms, problematic substance use, unhealthy alcohol use, and psychotic symptoms) was assessed. RESULTS Every one-point increase in the number of mental health conditions present was associated with a decrement in patient-provider communication (b = - 0.22, p < .001), self-efficacy (b = - 0.13, p = .012), and motivation for adherence (b = - 0.11, p = .039). CONCLUSION This study found cumulative burden of depression, problematic substance use, unhealthy alcohol use, and psychotic symptoms to be negatively associated with factors related to engagement in HIV care. Results highlight the importance of identification and treatment of challenges to mental health, in order to ameliorate their influence on engagement in HIV care.
Collapse
Affiliation(s)
- Omar Sued
- Fundacion Huesped, Buenos Aires, Argentina.
| | - Diego Cecchini
- Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina
- Helios Salud, Buenos Aires, Argentina
| | - John M Abbamonte
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lissa N Mandell
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nicholas V Cristofari
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Pedro Cahn
- Fundacion Huesped, Buenos Aires, Argentina
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Ana Crinejo
- Hospital Guillermo Rawson, Córdoba, Argentina
| | | | - Sergio Lupo
- Instituto Centralizado de Asistencia e Investigación Clínica Integral (CAICI), Rosario, Argentina
| | | | | | - Claudia Rodriguez
- Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina
| | - María José Rolón
- Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires, Argentina
| | - Alicia Sisto
- Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires, Argentina
| | - Liliana Trapé
- Instituto Centralizado de Asistencia e Investigación Clínica Integral (CAICI), Rosario, Argentina
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
6
|
Pirri S, Lorenzoni V, Turchetti G. Scoping review and bibliometric analysis of Big Data applications for Medication adherence: an explorative methodological study to enhance consistency in literature. BMC Health Serv Res 2020; 20:688. [PMID: 32709237 PMCID: PMC7379348 DOI: 10.1186/s12913-020-05544-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 07/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medication adherence has been studied in different settings, with different approaches, and applying different methodologies. Nevertheless, our knowledge and efficacy are quite limited in terms of measuring and evaluating all the variables and components that affect the management of medication adherence regimes as a complex phenomenon. The study aim is mapping the state-of-the-art of medication adherence measurement and assessment methods applied in chronic conditions. Specifically, we are interested in what methods and assessment procedures are currently used to tackle medication adherence. We explore whether Big Data techniques are adopted to improve decision-making procedures regarding patients' adherence, and the possible role of digital technologies in supporting interventions for improving patient adherence and avoiding waste or harm. METHODS A scoping literature review and bibliometric analysis were used. Arksey and O'Malley's framework was adopted to scope the review process, and a bibliometric analysis was applied to observe the evolution of the scientific literature and identify specific characteristics of the related knowledge domain. RESULTS A total of 533 articles were retrieved from the Scopus academic database and selected for the bibliometric analysis. Sixty-one studies were identified and included in the final analysis. The Morisky medication adherence scale (36%) was the most frequently adopted baseline measurement tool, and cardiovascular/hypertension disease, the most investigated illness (38%). Heterogeneous findings emerged from the types of study design and the statistical methodologies used to assess and compare the results. CONCLUSIONS Our findings reveal a lack of Big Data applications currently deployed to address or measure medication adherence in chronic conditions. Our study proposes a general framework to select the methods, measurements and the corpus of variables in which the treatment regime can be analyzed.
Collapse
Affiliation(s)
- Salvatore Pirri
- Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy
| | | | | |
Collapse
|
7
|
Chirambo L, Valeta M, Banda Kamanga TM, Nyondo-Mipando AL. Factors influencing adherence to antiretroviral treatment among adults accessing care from private health facilities in Malawi. BMC Public Health 2019; 19:1382. [PMID: 31660947 PMCID: PMC6816213 DOI: 10.1186/s12889-019-7768-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Private health facilities are increasingly being recognized as the neglected partner in the provision of HIV services. The non-adherence rate in the study sites ranged from 19 to 22%. This study explored the factors associated with non-adherence from antiretroviral therapy (ART) among adult patients accessing ART services at two privately owned urban health facilities in Malawi. METHODS We conducted a descriptive qualitative approach employing in-depth interviews among adults who either defaulted or were retained in HIV care in two privately owned facilities in Malawi from March to July 2017. We purposively selected participants and interviewed a total of 6 ART providers and 24 ART clients. Data were analyzed manually using a thematic approach. RESULTS Overall, participants identified four facilitators for retention in care and four broad categories of barriers namely individual, psychological, drug related and human resource related factors. The factors that facilitated retention in care included follow up visits after missing a visit, adequate information education and counseling, and supportive relationships. CONCLUSION The main reason for defaulting from antiretrovirals (ARVs) was fear of disclosing an HIV status to avert potential stigma and discrimination. In implementing ART clinics due consideration and strategies need to be adopted to ensure that privacy and confidentiality is preserved. Although adoption of all the key Malawi Implementing strategies like expert clients and a guardian may optimize retention in care, there is need for prior analysis of how those may lead to unintended disclosure which inadvertently affects adherence. Furthermore, private facilities should orient their clients to the public facilities within the catchment area so that clients have an option for alternative access to HIV care in the event of financial constraints.
Collapse
Affiliation(s)
- Lusungu Chirambo
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, Private Bag 360, Blantyre, Malawi
| | - Martha Valeta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, Private Bag 360, Blantyre, Malawi
| | - Tifiness Mary Banda Kamanga
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, Private Bag 360, Blantyre, Malawi
| | - Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, Blantyre, Malawi
| |
Collapse
|
8
|
Sued O, Cassetti I, Cecchini D, Cahn P, de Murillo LB, Weiss SM, Mandell LN, Soni M, Jones DL. Physician-delivered motivational interviewing to improve adherence and retention in care among challenging HIV-infected patients in Argentina (COPA2): study protocol for a cluster randomized controlled trial. Trials 2018; 19:396. [PMID: 30041703 PMCID: PMC6056946 DOI: 10.1186/s13063-018-2758-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 06/25/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND "Challenging" HIV-infected patients, those not retained in treatment, represent a critical focus for positive prevention, as linkage to care, early initiation of antiretroviral therapy, adherence and retention in treatment facilitate viral suppression, thus optimizing health and reducing HIV transmission. Argentina was one of the first Latin American countries to guarantee HIV prevention, diagnosis and comprehensive care services, including antiretroviral medication, which removed cost and access as barriers. Yet, dropout occurs at every stage of the HIV continuum. An estimated 110,000 individuals are HIV-infected in Argentina; of these, 70% have been diagnosed and 54% were linked to care. However, only 36% have achieved viral suppression and 31% of those diagnosed delayed entry to care. To achieve meaningful reductions in HIV infection at the community level, innovative strategies must be developed to re-engage patients. Motivational Interviewing (MI) is a patient-centered approach and has been used by therapists in Central and South America to enhance motivation and commitment in substance use and risk reduction. Our pilot feasibility study utilized culturally tailored MI in physicians to target patients not retained in treatment in public and private clinics in Buenos Aires, Argentina. Results demonstrated that a physician-based MI intervention was feasible and effective in enhanced and sustained patient adherence, viral suppression, and patient-physician communication and attitudes about treatment among these patients at 6 and 9 months post baseline. METHODS/DESIGN This clinical trial seeks to extend these findings in public and private clinics in four urban population centers in Argentina, in which clinics (n = 6 clinics, six MDs per clinic site) are randomized to experimental (physician MI Intervention) (n = 3) or control (physician Standard of Care) (n = 3) conditions in a 3:3 ratio. Using a cluster randomized clinical trial design, the study will test the effectiveness of a physician-based MI intervention to improve and sustain retention, adherence, persistence, and viral suppression among "challenging" patients (n = 420) over 24 months. DISCUSSION Results are anticipated to have significant public health implications for the implementation of MI to re-engage and retain patients in HIV treatment and care and improve viral suppression through high levels of medication adherence. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02846350 . Registered on 1 July 2016.
Collapse
Affiliation(s)
- Omar Sued
- Fundación Huésped, Pasaje Angel Peluffo 3932, C1202ABB Buenos Aires, Argentina
| | | | | | - Pedro Cahn
- Fundación Huésped, Pasaje Angel Peluffo 3932, C1202ABB Buenos Aires, Argentina
| | - Lina Bofill de Murillo
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL USA
| | - Stephen M. Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL USA
| | - Lissa N. Mandell
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL USA
| | - Manasi Soni
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL USA
| | - Deborah L. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL USA
| |
Collapse
|
9
|
Rodriguez VJ, Sued O, Cecchini D, Mandell LN, Bofill LM, Weiss SM, Cassetti I, Cahn P, Jones DL. Suicidality among nonadherent patients living with HIV in Buenos Aires, Argentina: prevalence and correlates. AIDS Care 2018; 30:1380-1387. [PMID: 29607661 DOI: 10.1080/09540121.2018.1458974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Of those in the general population hospitalized for suicidal ideation and suicide attempts in Argentina, many reattempt suicide and are readmitted. However, few studies in Argentina have examined suicidal ideation and suicide-related behaviors among people living with HIV (PLHIV) and none have examined these factors among nonadherent PLHIV, though the prevalence of suicidal ideation in this group may be higher than in the general population and also than in other groups of PLHIV. This study of PLHIV in Buenos Aires, Argentina, examined the correlates of suicidal ideation in nonadherent PLHIV. Nonadherent patients with HIV (N = 118) were recruited from two clinics providing outpatient healthcare services to PLHIV in Buenos Aires, Argentina. Participants completed assessments on demographic characteristics, depression and suicidality, stigma, and self-efficacy. Participants were HIV-infected men (51%) and women (49%) with a median age of 40 years (IQR = 11). About half had completed high school or more, two-thirds were employed, and had a mean monthly income of 4196.79 (SD = 3179.64) Argentine pesos (USD$221). Thirty-three (28% [95% CI 20.3, 37.3]) participants reported suicidal ideation in the past two weeks, and one-third (35.6% [27.1, 44.9]) reported lifetime suicidal ideation. In bivariate analyses, attending a public clinic, being female, younger, unemployed, and experiencing greater stigma and depression were associated with suicidal ideation. In multivariable logistic regression, stigma interacted with the number of years since HIV diagnosis to predict suicidal ideation. The impact of stigma on suicidal ideation decreased with time since HIV diagnosis, suggesting that suicidal ideation may arise following HIV diagnosis due to perception of HIV-related stigma. Interventions to reduce perceived stigma during the period following HIV diagnosis may reduce suicidal ideation in this population. Organizational initiatives that explore HIV stigma microagressions in the healthcare setting may be needed to optimize health outcomes.
Collapse
Affiliation(s)
- Violeta J Rodriguez
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.,d Department of Psychology , University of Georgia
| | - Omar Sued
- b Fundación Huésped , Buenos Aires , Argentina
| | | | - Lissa N Mandell
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Lina M Bofill
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Stephen M Weiss
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | | | - Pedro Cahn
- b Fundación Huésped , Buenos Aires , Argentina
| | - Deborah L Jones
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| |
Collapse
|
10
|
Jones DL, Sued O, Cecchini D, Bofill L, Cook R, Lucas M, Bordato A, Cassetti I, Cahn P, Weiss SM. Improving Adherence to Care Among "Hard to Reach" HIV-Infected Patients in Argentina. AIDS Behav 2016; 20:987-97. [PMID: 26152608 DOI: 10.1007/s10461-015-1133-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Many HIV-infected patients fail to achieve undetectable viral load and are not retained in care. This pilot study examined patients lost to care in public and private clinics in Buenos Aires, Argentina. The impact of patient and provider interventions was compared separately and collectively. In Phase 1, participants prescribed antiretrovirals and non-adherent to treatment in the prior 3-6 months (n = 60) were randomized to patient intervention or standard of care (SOC) and assessed over 12 months. In Phase 2, providers were trained in interviewing techniques and 60 additional patients were randomized to patient intervention or SOC condition. Averaged across patient intervention status, Phase 2 provider intervention patients reported the most improved adherence and viral suppression at 6 and 12 months. Adherence in "patient intervention only" improved at midpoint and returned to baseline at 12 months. Results suggest provider training sustained patient adherence and viral suppression among "hard to reach" patients.
Collapse
Affiliation(s)
- Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, 1400 NW 10th Ave., Miami, FL, 33136, USA.
| | - Omar Sued
- Clinical Research Department, Fundación Huésped, Buenos Aires, Argentina
| | | | - Lina Bofill
- Department of Psychiatry and Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, 1400 NW 10th Ave., Miami, FL, 33136, USA
| | - Ryan Cook
- Department of Psychiatry and Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, 1400 NW 10th Ave., Miami, FL, 33136, USA
| | - Mar Lucas
- Clinical Research Department, Fundación Huésped, Buenos Aires, Argentina
| | | | | | - Pedro Cahn
- Clinical Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, 1400 NW 10th Ave., Miami, FL, 33136, USA
| |
Collapse
|