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Poudel KC, Poudel-Tandukar K, Silwal RC, Chalise BS, Bertone-Johnson ER, Vidrine DJ. Feasibility, Acceptability, and Preliminary Effects of a Video-Based Intervention for Smoking Cessation Among People with HIV in Kathmandu, Nepal: A Single-Armed Pilot Study. AIDS Behav 2023; 27:3468-3477. [PMID: 37071334 DOI: 10.1007/s10461-023-04062-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/19/2023]
Abstract
Despite the evidence of the disproportionate burden of tobacco use among people with HIV (PWH), little effort has been made to design and test smoking cessation interventions for PWH in resource-limited countries. We assessed the feasibility, acceptability, and preliminary effects of a video-based smoking cessation intervention consisting of eleven 3-8-minute sessions among PWH in Nepal, a lower-middle-income country. Guided by the phased-based model, our 3-month intervention focused on setting the quit date, smoking cessation, and abstinence maintenance. We screened 103 PWH over three weeks for our single-arm trial, with 53 considered eligible and 48 recruited (91%). Forty-six participants watched all video clips, while two watched 7-9. All participants were retained at a 3-month follow-up. The 1-week point prevalence abstinence (self-report supported with expired carbon monoxide levels < 5ppm) at 3-month follow-up was 39.6%. Most (90%) participants reported "very much" or "much" comfort with watching the videos on their smartphones, and all would recommend the intervention to other PWH who smoke. Overall, our pilot trial demonstrated the feasibility, acceptability, and high-level efficacy of the video-based smoking cessation intervention highlighting its potential for scaling up in Nepal and other resource-limited countries.
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Affiliation(s)
- Krishna C Poudel
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 North Pleasant St., Arnold House, Amherst, MA, 01003-9304, USA.
- Institute for Global Health, University of Massachusetts Amherst, Amherst, MA, USA.
| | | | | | | | - Elizabeth R Bertone-Johnson
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 North Pleasant St., Arnold House, Amherst, MA, 01003-9304, USA
- Department of Biostatistics & Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Damon J Vidrine
- Moffit Cancer Center, Department of Health Outcomes and Behavior, Tampa, FL, USA
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Valenzuela-Oré F, Angulo-Bazán Y, Lazóriga-Sandoval LD, Cruz-Vilcarromero NL, Cubas-Sagardia CR. Factors influencing adherence to anti-retroviral therapy in amazonian indigenous people living with HIV/AIDS. BMC Public Health 2023; 23:497. [PMID: 36922774 PMCID: PMC10015934 DOI: 10.1186/s12889-023-15362-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/02/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Indigenous communities in Peru has been historically affected by high mortality rates attributable to HIV-AIDS infection, associated with a low access to health services, and socio-cultural barriers. In this context, the study aimed to describe factors associated with antiretroviral treatment adherence in people from Awajun and Wampis indigenous communities, living with HIV-AIDS in a Peruvian Amazonian region. METHODS A cross-sectional study was completed with a consecutive sample of people from indigenous communities (Awajun or Wampis) living with HIV, who were receiving antiretroviral treatment for at least the last three months. Participants were recruited between October 1 and December 30, 2021, from four districts of Bagua and Condorcanqui provinces in the Amazonian region. An ad-hoc questionnaire was used to collect information about demographic, economic, and socio-cultural factors and access to health services. The Simplified Medication Adherence Questionnaire (SMAQ) was used to evaluate adherence to antiretroviral therapy. Multivariate logistic regression analysis with backward stepwise was performed to explore factors that might influence adherence. RESULTS Of the 208 participants, 28.8% reported complete adherence to antiretroviral treatment. The multivariate logistic regression showed that occupation (aPR: 1.86; 95%CI 1.15-3.02), economic income (aPR: 0.64; 95%CI 0.41-0.99), and adverse reactions to antiretroviral therapy (aPR: 0.36; 95%CI 0.18-0.70) were related to complete adherence to medication. CONCLUSION Only a third of participants reported complete adherence to antiretroviral therapy. Factors associated with adherence to antiretroviral medication were related to socioeconomic conditions and adverse reactions to the therapeutic scheme. Interventions to improve adherence in indigenous people living with HIV should consider these factors in order to develop effective implementation strategies.
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Hossain F, Hasan M, Begum N, Mohan D, Verghis S, Jahan NK. Exploring the barriers to the antiretroviral therapy adherence among people living with HIV in Bangladesh: A qualitative approach. PLoS One 2022; 17:e0276575. [PMID: 36269716 PMCID: PMC9586390 DOI: 10.1371/journal.pone.0276575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 10/10/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Since the evolution of highly active antiretroviral therapy (ART), a near-perfect ART adherence level (>95%) is needed to control viral suppression. Non-adherence to treatment may lead to acquired immunodeficiency syndrome (AIDS) and drug resistance. Though the Bangladesh government provides free treatment and counselling services to people living with human immunodeficiency virus (PLHIV), only 22% of the identified PLHIV continue treatment. Therefore, this study aims to explore the barriers that obstruct the Bangladeshi PLHIV to ensure ART adherence. METHODS We conducted a qualitative study in Dhaka, Bangladesh, and recruited the sensitive study population following non-probability, mainly purposive sampling from a community-based registered organization for PLHIV. We conducted the in-depth interview using a semi-structured guideline with 15 consented respondents. We transcribed the audio-recorded interviews in the local language (Bangla) and then translated those into English for data analysis. During the data extraction process, the lead and corresponding authors independently extracted raw data to generate different themes and sub-themes and invited other authors to contribute when they could not solve any discrepancies. RESULTS The study identified three significant categories of barriers at the individual, community, and institutional levels that negatively interfered with ART adherence. The most dominant barriers were discrimination and rejection related to stigma, as almost all participants mentioned these barriers. Stigmatizing attitudes and the discriminatory act of the community people and healthcare providers critically affected their treatment adherence. Other leading barriers were improper inventory management of ART-related medicines and CD4 tests and lack of proper counselling. In addition, we found that a positive approach toward life and family support motivated some respondents to overcome the barriers. CONCLUSIONS We recommended strengthening Bangladesh's HIV/AIDS prevention, treatment, and management program with a special focus on the improvement of the supply chain of ART-related medicines and CD4 tests and ensuring proper counselling. In addition, we recommended strengthening the behaviour change communication and IEC activities at a large scale to destigmatize health facilities and community levels.
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Affiliation(s)
- Fariha Hossain
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
| | | | | | - Devi Mohan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
| | - Sharuna Verghis
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
| | - Nowrozy Kamar Jahan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
- * E-mail:
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Gordon TP, Talbert M, Mugisha MK, Herbert AE. Factors associated with HIV viral suppression among adolescents in Kabale district, South Western Uganda. PLoS One 2022; 17:e0270855. [PMID: 35980902 PMCID: PMC9387807 DOI: 10.1371/journal.pone.0270855] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 06/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background The goal of antiretroviral therapy is to achieve sustained human immune deficiency virus (HIV) viral suppression. However, research on factors associated with viral load suppression among adolescents in low and middle-income countries is limited. The objectives of this study were to determine HIV viral suppression levels among adolescents in Kabale district and the associated clinical, adherence and psychosocial factors. Methods Cross-sectional and retrospective cohort study designs were used. Two hundred and forty-nine adolescents living with HIV that attended clinics between September and October 2019 at nine health facilities were interviewed and their medical records reviewed. A data abstraction tool was used to collect clinical data from adolescent’s clinical charts, face to face interviews were conducted using semi-structured questionnaire adopted from the HEADS tool and in-depth interviews conducted with ten key informants. Qualitative data was analyzed using thematic content analysis. Logistic regression was used to determine the magnitude by which clinical and psychosocial factors influence viral load suppression. Odds Ratios (ORs) were used for statistical associations at 95% confidence interval considering statistical significance for p-values less than 0.05. Qualitative data collected from Key informants to support our quantitative findings was analyzed using thematic content analysis. Results HIV viral suppression among (n = 249) adolescents was at 81%. Having no severe opportunistic infections was associated with viral load suppression among adolescent living with HIV (OR = 1.09; 95%CI [1.753–4.589]; p<0.001) as well as having no treatment interruptions (OR = 0.86; 95% CI [2.414–6.790]; p = 0.004). Belonging to a support group (OR = 1.01; 95% CI [1.53–4.88]; P = 0.020), having parents alive (OR = 2.04; 95% CI[1.02–4.12]; P = 0.047) and having meals in a day (OR = 5.68; C.I = 2.38–6.12, P = 0.010), were significantly associated to viral load suppression. The findings also indicated that long distances from health facilities, transport challenges and unprofessional conduct of health workers that make adolescent unwelcome at health facilities negatively affected viral suppression among adolescents. Conclusion The findings indicate that HIV viral suppression among adolescents on ART was at 81%. Kabale district was likely not to achieve the third 90 of the UNAIDS 90-90-90 global target for this population category. The findings further indicate that having no severe opportunistic infection and no treatment interruptions, good nutrition status, peer support and support from significant others, were highly associated with viral load suppression.
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Affiliation(s)
- Tugume Peterson Gordon
- Department of Public Health, Faculty of Health Sciences and Nursing, Bishop Stuart University, Mbarara, Uganda
- * E-mail:
| | - Muhwezi Talbert
- Department of Public Health, Faculty of Health Sciences and Nursing, Bishop Stuart University, Mbarara, Uganda
| | | | - Ainamani Elvis Herbert
- Department of Public Health, Faculty of Health Sciences and Nursing, Bishop Stuart University, Mbarara, Uganda
- Department of Mental Health, Kabale University School of Medicine, Kabale, Uganda
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Predictors of Viral Non-Suppression among Patients Living with HIV under Dolutegravir in Bunia, Democratic Republic of Congo: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031085. [PMID: 35162109 PMCID: PMC8834045 DOI: 10.3390/ijerph19031085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 01/18/2023]
Abstract
The Democratic Republic of the Congo adopted the integrase inhibitor dolutegravir (DTG) as part of its preferred first-line HIV treatment regimen in 2019. This study aimed to identify predictors of viral non-suppression among HIV-infected patients under a DTG-based regimen in the context of ongoing armed conflict since 2017 in the city of Bunia in the DRC. We conducted a cohort study of 468 patients living with HIV under DTG in all health facilities in Bunia. We calculated the proportion of participants with an HIV RNA of below 50 copies per milliliter. About three in four patients (72.8%) in this cohort had a viral load (VL) of <50 copies/mL after 6–12 months. After controlling for the effect of other covariates, the likelihood of having non-suppression remained significantly lower among the 25–34 age group and self-reported naïve patients with a baseline VL of ≥50 copies/mL. The likelihood of having non-suppression remained significantly higher among those who were at advanced stages of the disease, those with abnormal serum creatinine, those with high baseline HIV viremia over 1000 copies/mL, and the Sudanese ethnic group compared to the reference groups. This study suggests that we should better evaluate adherence, especially among adolescents and economically vulnerable populations, such as the Sudanese ethnic group in the city of Bunia. This suggests that an awareness of the potential effects of DTG and tenofovir is important for providers who take care of HIV-positive patients using antiretroviral therapy (ART), especially those with abnormal serum creatinine levels before starting treatment.
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Hashiba C, Imahashi M, Imamura J, Nakahata M, Kogure A, Takahashi H, Yokomaku Y. Factors Associated with Attrition: Analysis of an HIV Clinic in Japan. J Immigr Minor Health 2021; 23:250-256. [PMID: 32072376 PMCID: PMC7914243 DOI: 10.1007/s10903-020-00982-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study evaluated the impact of a public medical interpreter on the follow-up clinic attendance rate of foreign-born people with HIV who live in Japan. Participants were patients who visited Nagoya Medical Center from 2009 to 2016. Lost to follow-up was defined as an absence from follow-up visits for more than six months without any notification. A log-rank test was conducted to compare the lost-to-follow-up rates by patients’ nation of origin and medical interpreter use. Of the 931 participants, 114 were foreign patients, whose overall attendance rate at 5 years was 75.5%, which was significantly lower than that of Japanese patients (94.1%, p < 0.001). There was no significant difference in regular attendance with respect to medical interpreter use (p = 0.09). Social support in addition to a medical interpreter may be needed to improve attendance rates in the study population.
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Affiliation(s)
- Chieko Hashiba
- Department of Nursing, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Mayumi Imahashi
- Department of Infectious Diseases, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan.
| | - Junji Imamura
- Department of Infectious Diseases, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan.,Department of Infectious Diseases, Sendai Medical Center, 2-8-8 Miyagino Miyagino-ku, Sendai, 983-8520, Japan
| | - Masashi Nakahata
- Department of Infectious Diseases, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Ayumi Kogure
- Department of Infectious Diseases, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Hideto Takahashi
- National Institute of Public Health, 2-3-6 Minami, Wako, 351-0197, Japan
| | - Yoshiyuki Yokomaku
- Department of Infectious Diseases, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
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Desalegn M, Seyoum D, Tola EK, Tsegaye Gayesa R. Determinants of first-line antiretroviral treatment failure among adult HIV patients at Nekemte Specialized Hospital, Western Ethiopia: Unmatched case-control study. SAGE Open Med 2021; 9:20503121211030182. [PMID: 34262767 PMCID: PMC8252348 DOI: 10.1177/20503121211030182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/16/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In Ethiopia, only a few studies were conducted to determine factors contributing to antiretroviral treatment failure, in general, and there are no published data in the study area, in particular. Thus, the aim of the study was to assess the determinants of first-line treatment failure among adult HIV patients on antiretroviral treatment at Nekemte Specialized Hospital, western Ethiopia. METHODS The hospital-based 1:2 unmatched case-control study was conducted in Nekemte Specialized Hospital from 1 August to 30 September, 2019, on 252 HIV-positive patients receiving antiretroviral treatment (86 cases and 166 controls). Cases were selected from patients who were switched to second-line antiretroviral treatment regimen after first-line antiretroviral treatment failure. Controls were from those who are on the first-line antiretroviral regimens for at least 6 months. Data were collected by two trained clinical nurses. Record review and an interviewer-administered questionnaire were used to collect data. Data were entered into Epi-Data, version 7.2.2, and then exported to SPSS, version 25, for analysis. The association between treatment failure and each covariate was assessed by bivariate analysis to identify candidate variables at p value < 0.25. All candidate variables were entered into multivariate analysis done in stepwise backward likelihood ratio to declare statistical significance association at p value < 0.05, 95% confidence interval. RESULTS Data from a total of 252 (86 cases and 166 controls) patients were extracted at a response rate of 98.4%. Statistically higher odds of first-line treatment failure were observed among those who started treatment at an advanced stage (Baseline World Health Organization stage 3 o r4 (adjusted odds ratio = 3.12, 95% confidence interval: 1.55-6.26), lower Baseline CD4 count < 100 cells (adjusted odds ratio = 3.06, 95 % confidence interval: 1.45-6.50), lack of participation in a support group (adjusted odds ratio = 4.03, 95% confidence interval: 1.98-8.21), history of antiretroviral treatment discontinuation for greater than 1 month (adjusted odds ratio = 2.36, 95% confidence interval: 1.17-4.78) and poor adherence to antiretroviral treatment (adjusted odds ratio = 3.09, 95% confidence interval: 1.54-6.19). CONCLUSION Antiretroviral treatment initiation at an advanced stage, lower CD4 count, no participation in a support group, and poor adherence were determinants of treatment first-line antiretroviral treatment failure. Therefore, health care providers and program developers should give special attention to; early diagnosis and start of treatment, encouraging patients to participate in a support group, trace patients early, and attentively follow patients to improve their adherence to antiretroviral treatment.
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Affiliation(s)
- Mengistu Desalegn
- Department of Public health, Nekemte Health Science College, Nekemte, Ethiopia
| | - Dejene Seyoum
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Edosa Kifle Tola
- Department of Medical Laboratory Science, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Reta Tsegaye Gayesa
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Ayer R, Poudel KC, Kikuchi K, Ghimire M, Shibanuma A, Jimba M. Nurse-Led Mobile Phone Voice Call Reminder and On-Time Antiretroviral Pills Pick-Up in Nepal: A Randomized Controlled Trial. AIDS Behav 2021; 25:1923-1934. [PMID: 33389377 DOI: 10.1007/s10461-020-03122-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
This study investigates the efficacy of a nurse-led mobile phone voice call reminder intervention in improving on-time antiretroviral (ARV) pills collection in Nepal. Between October and December 2017, 468 HIV-positive individuals were recruited randomly and assigned to either nurse-led mobile phone voice call reminder (intervention) group or voice call with health promotion message (control) group, 234 were allocated to each group. We assessed on-time pills pick-up at baseline and six-month follow-up and analyzed it by intention-to-treat method. In the intervention group, participants improved their on-time ARV pills pick-up from 60% (141/234) at baseline to 71% (151/234) at the six-month follow-up. After adjusting for covariates, those in the intervention group were significantly more likely to pick-up their pills on-time than those in the control group (intervention × time; adjusted odds ratio 2.02, 95% CI 1.15-3.55). Nurse-led mobile phone voice call reminder is efficacious to improve on-time ARV collection.
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Sithole Z, Mbizvo E, Chonzi P, Mungati M, Juru TP, Shambira G, Gombe NT, Tshimanga M. Virological failure among adolescents on ART, Harare City, 2017- a case-control study. BMC Infect Dis 2018; 18:469. [PMID: 30227831 PMCID: PMC6145182 DOI: 10.1186/s12879-018-3372-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Zimbabwe is on track towards achieving viral suppression among adults (87%). However, adolescents have only achieved 44% by 2016. In Harare city, 57% of adolescents had attained viral suppression after 12 months on ART compared to 88% among adults. We determined factors associated with virological failure among adolescents (age 10-19 years) on antiretroviral therapy (ART) in Harare city. METHODS We conducted a one to one unmatched case control study among 102 randomly recruited case: control pairs at the two main infectious disease hospitals in Harare. A case was any adolescent who presented with VL > 1000c/ml after at least 12 months on ART. A control was any adolescent who presented with VL < 1000c/ml after at least 12 months on ART. Interviewer administered questionnaires were used to collect data. Epi Info 7 was used to generate frequencies, means, proportions, ORs and p-values at 95% CI. RESULTS We interviewed 102 case-control pairs. Poor adherence to ART [aOR = 8.15, 95% CI (2.80-11.70)], taking alcohol [aOR = 8.46, 95% CI (3.22-22.22)] and non- disclosure of HIV status [aOR = 4.56, 95% CI (2.20-9.46)] were independent risk factors for virological failure. Always using a condom [aOR = 0.04, 95% CI (0.01-0.35)], being on second line treatment [aOR = 0.04, 95% CI (0.23-0.81)] and belonging to a support group [aOR = 0.41, 95% CI (0.21-0.80)] were protective. CONCLUSION Poor adherence, alcohol consumption and non-disclosure increased the odds of virological failure. Based on these findings support should focus on behavior change and strengthening of peer to peer projects to help address issues related to disclosure and adherence. Further operational research should aim to define other components of effective adherence support for adolescents with virological failure.
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Affiliation(s)
- Zvanaka Sithole
- MPH Programme, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Elizabeth Mbizvo
- MPH Programme, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | | | - More Mungati
- Elizabeth Glaser Pediatirc AIDS Foundation, Lesotho, Swaziland
| | - Tsitsi Patience Juru
- MPH Programme, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Gerald Shambira
- MPH Programme, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Notion Tafara Gombe
- MPH Programme, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Mufuta Tshimanga
- MPH Programme, Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
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Jiamsakul A, Kerr SJ, Kiertiburanakul S, Azwa I, Zhang F, Chaiwarith R, Wong W, Ly PS, Kumarasamy N, Ditangco R, Pujari S, Yunihastuti E, Do CD, Merati TP, Nguyen KV, Lee MP, Choi JY, Oka S, Kantipong P, Sim BLH, Ng OT, Ross J, Law M. Early suboptimal ART adherence was associated with missed clinical visits in HIV-infected patients in Asia. AIDS Care 2018; 30:1560-1566. [PMID: 30021450 DOI: 10.1080/09540121.2018.1499859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Missed clinic visits can lead to poorer treatment outcomes in HIV-infected patients. Suboptimal antiretroviral therapy (ART) adherence has been linked to subsequent missed visits. Knowing the determinants of missed visits in Asian patients will allow for appropriate counselling and intervention strategies to ensure continuous engagement in care. A missed visit was defined as having no assessments within six months. Repeated measures logistic regression was used to analyse factors associated with missed visits. A total of 7100 patients were included from 12 countries in Asia with 2676 (37.7%) having at least one missed visit. Patients with early suboptimal self-reported adherence <95% were more likely to have a missed visit compared to those with adherence ≥95% (OR = 2.55, 95% CI(1.81-3.61)). Other factors associated with having a missed visit were homosexual (OR = 1.45, 95%CI(1.27-1.66)) and other modes of HIV exposure (OR = 1.48, 95%CI(1.27-1.74)) compared to heterosexual exposure; using PI-based (OR = 1.33, 95%CI(1.15-1.53) and other ART combinations (OR = 1.79, 95%CI(1.39-2.32)) compared to NRTI+NNRTI combinations; and being hepatitis C co-infected (OR = 1.27, 95%CI(1.06-1.52)). Patients aged >30 years (31-40 years OR = 0.81, 95%CI(0.73-0.89); 41-50 years OR = 0.73, 95%CI(0.64-0.83); and >50 years OR = 0.77, 95%CI(0.64-0.93)); female sex (OR = 0.81, 95%CI(0.72-0.90)); and being from upper middle (OR = 0.78, 95%CI(0.70-0.80)) or high-income countries (OR = 0.42, 95%CI(0.35-0.51)), were less likely to have missed visits. Almost 40% of our patients had a missed clinic visit. Early ART adherence was an indicator of subsequent clinic visits. Intensive counselling and adherence support should be provided at ART initiation in order to optimise long-term clinic attendance and maximise treatment outcomes.
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Affiliation(s)
| | - Stephen J Kerr
- b HIV-NAT, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand
| | | | - Iskandar Azwa
- d University of Malaya Medical Centre , Kuala Lumpur , Malaysia
| | - Fujie Zhang
- e Beijing Ditan Hospital, Capital Medical University , Beijing , People's Republic of China
| | - Romanee Chaiwarith
- f Research Institute for Health Sciences , Chiang Mai University , Chiang Mai , Thailand
| | - Wingwai Wong
- g Taipei Veterans General Hospital , Taipei , Taiwan
| | - Penh Sun Ly
- h National Center for HIV/AIDS, Dermatology and STDs , Phnom Penh , Cambodia.,i University of Health Sciences , Phnom Penh , Cambodia
| | | | - Rossana Ditangco
- k Research Institute for Tropical Medicine , Manila , Philippines
| | | | - Evy Yunihastuti
- m Working Group on AIDS, Faculty of Medicine , University of Indonesia/Cipto Mangunkusumo Hospital , Jakarta , Indonesia
| | | | - Tuti Parwati Merati
- o Faculty of Medicine , Udayana University & Sanglah Hospital , Bali , Indonesia
| | | | - Man Po Lee
- q Queen Elizabeth Hospital , Hong Kong , People's Republic of China
| | - Jun Yong Choi
- r Division of Infectious Diseases, Department of Internal Medicine , Yonsei University College of Medicine , Seoul , South Korea
| | - Shinichi Oka
- s National Center for Global Health and Medicine , Tokyo , Japan
| | | | | | - Oon Tek Ng
- v Department of Infectious Diseases , Tan Tock Seng Hospital , Singapore , Singapore
| | - Jeremy Ross
- w TREAT Asia, amfAR - The Foundation for AIDS Research , Bangkok , Thailand
| | - Matthew Law
- a The Kirby Institute , UNSW Sydney , NSW , Australia
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- a The Kirby Institute , UNSW Sydney , NSW , Australia
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Abdulrahman SA, Rampal L, Othman N, Ibrahim F, Hayati KS, Radhakrishnan AP. Sociodemographic profile and predictors of outpatient clinic attendance among HIV-positive patients initiating antiretroviral therapy in Selangor, Malaysia. Patient Prefer Adherence 2017; 11:1273-1284. [PMID: 28794617 PMCID: PMC5538701 DOI: 10.2147/ppa.s141609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Inconsistent literature evidence suggests that sociodemographic, economic, and system- and patient-related factors are associated with clinic attendance among the HIV-positive population receiving antiretroviral therapy (ART) around the world. We examined the factors that predict outpatient clinic attendance among a cohort of HIV-positive patients initiating ART in Selangor, Malaysia. PATIENTS AND METHODS This cross-sectional study analyzed secondary data on outpatient clinic attendance and sociodemographic, economic, psychosocial, and patient-related factors among 242 adult Malaysian patients initiating ART in Selangor, Malaysia. Study cohort was enrolled in a parent randomized controlled trial (RCT) in Hospital Sungai Buloh Malaysia between January and December 2014, during which peer counseling, medication, and clinic appointment reminders were provided to the intervention group through short message service (SMS) and telephone calls for 24 consecutive weeks. Data on outpatient clinic attendance were extracted from the hospital electronic medical records system, while other patient-level data were extracted from pre-validated Adult AIDS Clinical Trial Group (AACTG) adherence questionnaires in which primary data were collected. Outpatient clinic attendance was categorized into binary outcome - regular attendee and defaulter categories - based on the number of missed scheduled outpatient clinic appointments within a 6-month period. Multivariate regression models were fitted to examine predictors of outpatient clinic attendance using SPSS version 22 and R software. RESULTS A total of 224 (93%) patients who completed 6-month assessment were included in the model. Out of those, 42 (18.7%) defaulted scheduled clinic attendance at least once. Missed appointments were significantly more prevalent among females (n=10, 37.0%), rural residents (n=10, 38.5%), and bisexual respondents (n=8, 47.1%). Multivariate binary logistic regression analysis showed that Indian ethnicity (adjusted odds ratio [AOR] =0.235; 95% CI [0.063-0.869]; P=0.030) and heterosexual orientation (AOR =4.199; 95% CI [1.040-16.957]; P=0.044) were significant predictors of outpatient clinic attendance among HIV-positive patients receiving ART in Malaysia. CONCLUSION Ethnicity and sexual orientation of Malaysian patients may play a significant role in their level of adherence to scheduled clinic appointments. These factors should be considered during collaborative adherence strategy planning at ART initiation.
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Affiliation(s)
- Surajudeen Abiola Abdulrahman
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor
- Department of Public Health Medicine, Penang Medical College, George Town, Penang
| | - Lekhraj Rampal
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor
| | - Norlijah Othman
- Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor
| | - Faisal Ibrahim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor
| | - Kadir Shahar Hayati
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor
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