Predicting adherence to antiretroviral therapy among pregnant women in Guyana: Utility of the Health Belief Model

Viral suppression and associated factors among children tested for HIV viral load at Amhara Public Health Institute, Dessie Branch, Ethiopia: a cross-sectional study

OBJECTIVE

This study aims to assess viral suppression and associated factors among children tested for HIV viral load at the Amhara Public Health Institute, Dessie Branch, Ethiopia.

DESIGN

An institutional cross-sectional study was conducted. An observational checklist was used to collect the data. Data were entered into EpiData and analysed using SPSS (V.25). The data were analysed descriptively. Variables with p=0.25 from the bivariable analysis were entered into a multivariable logistic regression model, and significant variables (p=0.05) were retained in the multivariable model.

SETTING AND PARTICIPANTS

This cross-sectional study was conducted among 522 randomly selected children tested for HIV viral load at the Amhara Public Health Institute, Dessie Branch, Ethiopia. The study included children under the age of 15 years with complete records.

RESULTS

Viral suppression was 73% (95% CI: 60.41% to 77.63%). Treatment duration on antiretroviral therapy (adjusted OR (AOR)=0.207; 95% CI: 0.094 to 0.456) and regimen substitution (AOR=0.490; 95% CI: 0.306 to 0.784) were significantly associated with viral suppression rate.

CONCLUSIONS

In this study, the overall magnitude of viral suppression in Amhara Public Health Institute, Dessie Branch is low as compared with the WHO's 95% viral suppression target. Viral suppression was significantly associated with antiretroviral therapy duration and regimen substitution.

Factors influencing adherence to antiretroviral therapy among HIV/AIDS patients in the Ga West Municipality, Ghana

OBJECTIVES

Antiretroviral therapy (ART) is used to suppress the HIV viral load but requires optimal adherence to be effective. This study examined the factors influencing ART adherence among HIV-positive clients in the Ga West Municipality, Ghana using the Health Belief Model (HBM).

METHODS

A facility-based cross-sectional design was adopted among 397 HIV clients aged 18 years and above. Data were collected using an interviewer-administered questionnaire and analysed using Stata version 16.0. Binary logistic regression was performed at the P < 0.05 level.

RESULTS

Adherence to ART was 44.6%. Clients who took less than 30 minutes to reach ART sites were 59% less likely to adhere to ART (odds ratio (OR) 0.41, 95% confidence interval (CI) 0.20-0.82). Clients who thought they lost income when they went to obtain their ART refill were more likely to adhere to ART (OR 1.71, 95% CI 1.04-2.83), as were those who developed side effects (OR 1.74, 95% CI 1.05-2.89) (perceived barriers). Clients who had confidence in their ability to take their medications (self-efficacy) (OR 1.86, 95% CI 1.05-3.31) and those who received reminders from health workers (cues to action) (OR 1.91, 95% CI 1.04-3.53) were more likely to adhere to ART.

CONCLUSIONS

Interventions should focus on increasing client confidence in adhering to ART. Providers should be empowered to provide reminders to patients.

HIV diagnosis period influences ART initiation: findings from a prospective cohort study in China

Background

We estimated the predictive effects of ART-related perceptions on the actual ART uptake behavior among ART naïve PLWH stratified by different time of HIV diagnosis under the new strategy.

Methods

A prospective cohort study was conducted among ART naïve PLWH in Guangzhou, China from June 2016 to June 2017. Cox regression model was used to evaluate the predictive effects of ART-related perceptions on ART initiation among PLWH stratified by different timepoint of HIV diagnosis (i.e., before or after the update of the new treatment policy).

Results

Among 411 participants, 150 and 261 were diagnosed before (pre-scaleup group) and after (post-scaleup group) the implementation of the new strategy, respectively. The ART initiation rate in the post-scaleup group (88.9%) was higher than that in the pre-scaleup group (73.3%) (p < 0.001). A significant difference of mean score was detected in each HBM construct between pre- and post-scaleup groups (p < 0.05). After adjusting for significant background variables, among all participants, only the self-efficacy [adjusted HR (HRa) = 1.23, 95% CI 1.06 to 1.43, p = 0.006], has a predictive effect on ART initiation; in pre-scaleup group, all constructs of HBM-related ART perceptions were predictors of ART initiation (HRa = 0.71 to 1.83, p < 0.05), while in post-scaleup group, no significant difference was found in each construct (p > 0.05).

Conclusions

The ART initiation rate was high particularly among participants who diagnosed after the new treatment strategy. The important role of the time of HIV diagnosis on ART initiation identified in this study suggested that future implementation interventions may consider to modify the ART-related perceptions for HIV patients who diagnosed before the implementation of the new ART strategy, while expand the accessibility of ART service for those who diagnosed after the implementation of the new strategy.

Socioeconomic and Demographic Statuses as Determinants of Adherence to Antiretroviral Treatment in HIV Infected Patients: A Systematic Review of the Literature

BACKGROUND

Socioeconomic and demographic statuses are associated with adherence to the treatment of patients with several chronic diseases. However, there is a controversy regarding their impact on adherence among HIV/AIDS patients. Thus, we performed a systematic review of the evidence regarding the association of socioeconomic and demographic statuses with adherence to antiretroviral therapy (ART) among HIV/AIDS patients.

METHODS

The PubMed database was used to search and identify studies concerning about socioeconomic and demographic statuses and HIV/AIDS patients. Data were collected on the association between adherence to ART and varies determinants factors of socioeconomic (income, education, and employment/occupation) and socio-demographic (sex and age).

FINDINGS

From 393 potentially-relevant articles initially identified, 35 original studies were reviewed in detail, which contained data that were helpful in evaluating the association between socioeconomic/ demographic statuses and adherence to ART among HIV patients. Two original research study has specifically focused on the possible association between socioeconomic status and adherence to ART. Income, level of education, and employment/occupational status were significantly and positively associated with the level of adherence in 7 studies (36.8%), 7 studies (28.0%), and 4 studies (23.5%) respectively out of 19, 25, and 17 studies reviewed. Sex (being male), and age (per year increasing) were significantly and positively associated with the level of adherence in 5 studies (14.3%), and 9 studies (25.7%) respectively out of 35 studies reviewed. However, the determinant of socioeconomic and demographic statuses was not found to be significantly associated with adherence in studies related to income 9(47.4%), education 17(68.0%), employment/ occupational 10(58.8%), sex 27(77.1%), and age 25(71.4%).

CONCLUSION

The majority of the reviewed studies reported that there is no association between socio- demographic and economic variables and adherence to therapy. Whereas, some studies show that age of HIV patients (per year increasing) and sex (being male) were positively associated with adherence to ART. Among socio-economic factors, the available evidence does not provide conclusive support for the existence of a clear association with adherence to ART among HIV patients. There seems to be a positive trend between socioeconomic factors and adherence to ART in some of the reviewed studies.

Intention to start ART after the launch of expanded treatment strategy among people living with HIV in China: a behavioral theory-based cross-sectional study

This study investigated the prevalence of intention to start antiretroviral therapy (ART) immediately among people living with HIV (PLWH) in China and associated perceptions toward ART based on behavioral theories. The study was initiated after the launch of an expanded ART strategy. A cross-sectional study was conducted among 450 PLWH who were ART naive in the city of Guangzhou, China, from June 2016 to February 2017. Among the participants, 311 (69.1%) showed intention to start ART immediately. The summary logistic regression analysis indicated that intention to start ART immediately was significantly associated with perceived severity [multivariate odds ratios (OR_m) = 1.62, 95%CI = 1.15-2.28, p < 0.01], perceived barriers (OR_m =0.56, 95%CI = 0.38-0.84, p < 0.01), self-efficacy (OR_m =2.90, 95%CI = 2.05-4.09, p < 0.001), and subjective norms (OR_m =1.95, 95%CI = 1.17-3.25, p < 0.05). The intention to start ART immediately among PLWH in Guangzhou was below the 90-90-90 target. Further promotion research should focus on these perceptional factors.