Factors associated with different patterns of nonadherence to HIV care in dar es salaam, Tanzania

Gabriela Poles; Michelle Li; Hellen Siril; Aisa Mhalu; Claudia Hawkins; Sylvia Kaaya; Eric Aris; Guerino Chalamilla; Lisa R. Hirschhorn

doi:10.1177/1545109712467068

Factors associated with different patterns of nonadherence to HIV care in dar es salaam, Tanzania

Gabriela Poles, Michelle Li, Hellen Siril, Aisa Mhalu, Claudia Hawkins, Sylvia Kaaya, Eric Aris, Guerino Chalamilla, Lisa R. Hirschhorn^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

19 Scopus citations

Abstract

Health system responsiveness (HSR), a measure of patient health care experience, may influence adherence to HIV/AIDS care and be an important predictor of outcomes. We studied the relationship between HSR, patient factors, and visit nonadherence in 16 President's Emergency Plan for AIDS Relief-supported HIV/AIDS clinics in Dar es Salaam. An HSR survey was administered in 2009, and all clinic visits 1 year following the interviews were analyzed for 720 patients on antiretrovirals (ARVs). Definitions of visit nonadherence were (1) low visit constancy ([VC], no visit in ≥1 quarter), (2) gaps in care (>60 days between visits), (3) no visit in last quarter (VLQ). The relationships between factors were analyzed using multivariate analysis with adjusted odds ratio (AOR) and 95% confidence intervals (CI) reported. Few patients were nonadherent using VLQ (14%) and VC (28%). Gaps in care were more common (49.6%) and associated with younger age (AOR: 3.86 [2.02-7.40]), no explanation of side effects (AOR: 2.21 [1.49-3.28]), and shorter antiretroviral therapy (ART) duration (0-3 months AOR: 1.49 [1.09-2.03]; 3-6 months AOR: 2.44 [1.40-4.25]). No VLQ was associated with younger age (AOR: 3.40 [1.63-7.07]), poor health care worker (HCW) communication (AOR: 4.83 [1.39-16.78]), and less time on ART (0-3 months AOR: 5.04 [2.47-10.30]; 3-6 months AOR: 3.09 [1.72-5.57]). Younger age, poor HCW communication, and shorter ART duration also predicted lower VC, as did higher patient-HCW ratios. The rates of visit nonadherence differed based on the definitions used. Younger age, shorter time on ART, and poor HCW communication predicted lower adherence regardless of the definition. More work is needed to understand the relationship between HSR, patient factors, and different patterns of visit nonadherence and their impact on ART outcomes.

Original language	English (US)
Pages (from-to)	78-84
Number of pages	7
Journal	Journal of the International Association of Providers of AIDS Care
Volume	13
Issue number	1
DOIs	https://doi.org/10.1177/1545109712467068
State	Published - Jan 2014

Funding

The authors would like to thank the clinic’s patients, staff, site managers, and supervisors of all the sites that participated in this study, Harvard University Center for AIDS Research (CFAR), which supported and funded the study through National Institutes of Health (NIH) funded program (P30AI060354), as well as the Doris Duke Charitable Foundation to Harvard University to fund Clinical Research Fellow Gabriela Poles. This publication’s contents are solely the responsibility of the authors and do not necessarily represent the views of the aforementioned organizations. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Harvard University Center for AIDS Research (CFAR) supported and funded the study through National Institutes of Health (NIH) funded program (P30AI060354), as well as the Doris Duke Charitable Foundation to Harvard University funded Clinical Research Fellow Gabriela Poles.

Keywords

HIV/AIDS
adherence
health systems responsiveness
patient satisfaction
resource-limited settings

ASJC Scopus subject areas

Infectious Diseases
Dermatology
Immunology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1177/1545109712467068

Cite this

@article{17cedcf30ec74143abba1fba94e51c8f,

title = "Factors associated with different patterns of nonadherence to HIV care in dar es salaam, Tanzania",

abstract = "Health system responsiveness (HSR), a measure of patient health care experience, may influence adherence to HIV/AIDS care and be an important predictor of outcomes. We studied the relationship between HSR, patient factors, and visit nonadherence in 16 President's Emergency Plan for AIDS Relief-supported HIV/AIDS clinics in Dar es Salaam. An HSR survey was administered in 2009, and all clinic visits 1 year following the interviews were analyzed for 720 patients on antiretrovirals (ARVs). Definitions of visit nonadherence were (1) low visit constancy ([VC], no visit in ≥1 quarter), (2) gaps in care (>60 days between visits), (3) no visit in last quarter (VLQ). The relationships between factors were analyzed using multivariate analysis with adjusted odds ratio (AOR) and 95% confidence intervals (CI) reported. Few patients were nonadherent using VLQ (14%) and VC (28%). Gaps in care were more common (49.6%) and associated with younger age (AOR: 3.86 [2.02-7.40]), no explanation of side effects (AOR: 2.21 [1.49-3.28]), and shorter antiretroviral therapy (ART) duration (0-3 months AOR: 1.49 [1.09-2.03]; 3-6 months AOR: 2.44 [1.40-4.25]). No VLQ was associated with younger age (AOR: 3.40 [1.63-7.07]), poor health care worker (HCW) communication (AOR: 4.83 [1.39-16.78]), and less time on ART (0-3 months AOR: 5.04 [2.47-10.30]; 3-6 months AOR: 3.09 [1.72-5.57]). Younger age, poor HCW communication, and shorter ART duration also predicted lower VC, as did higher patient-HCW ratios. The rates of visit nonadherence differed based on the definitions used. Younger age, shorter time on ART, and poor HCW communication predicted lower adherence regardless of the definition. More work is needed to understand the relationship between HSR, patient factors, and different patterns of visit nonadherence and their impact on ART outcomes.",

keywords = "HIV/AIDS, adherence, health systems responsiveness, patient satisfaction, resource-limited settings",

author = "Gabriela Poles and Michelle Li and Hellen Siril and Aisa Mhalu and Claudia Hawkins and Sylvia Kaaya and Eric Aris and Guerino Chalamilla and Hirschhorn, {Lisa R.}",

note = "Funding Information: The authors would like to thank the clinic{\textquoteright}s patients, staff, site managers, and supervisors of all the sites that participated in this study, Harvard University Center for AIDS Research (CFAR), which supported and funded the study through National Institutes of Health (NIH) funded program (P30AI060354), as well as the Doris Duke Charitable Foundation to Harvard University to fund Clinical Research Fellow Gabriela Poles. This publication{\textquoteright}s contents are solely the responsibility of the authors and do not necessarily represent the views of the aforementioned organizations. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Harvard University Center for AIDS Research (CFAR) supported and funded the study through National Institutes of Health (NIH) funded program (P30AI060354), as well as the Doris Duke Charitable Foundation to Harvard University funded Clinical Research Fellow Gabriela Poles.",

year = "2014",

month = jan,

doi = "10.1177/1545109712467068",

language = "English (US)",

volume = "13",

pages = "78--84",

journal = "Journal of the International Association of Providers of AIDS Care",

issn = "2325-9574",

publisher = "SAGE Publications Inc.",

number = "1",

}

TY - JOUR

T1 - Factors associated with different patterns of nonadherence to HIV care in dar es salaam, Tanzania

AU - Poles, Gabriela

AU - Li, Michelle

AU - Siril, Hellen

AU - Mhalu, Aisa

AU - Hawkins, Claudia

AU - Kaaya, Sylvia

AU - Aris, Eric

AU - Chalamilla, Guerino

AU - Hirschhorn, Lisa R.

N1 - Funding Information: The authors would like to thank the clinic’s patients, staff, site managers, and supervisors of all the sites that participated in this study, Harvard University Center for AIDS Research (CFAR), which supported and funded the study through National Institutes of Health (NIH) funded program (P30AI060354), as well as the Doris Duke Charitable Foundation to Harvard University to fund Clinical Research Fellow Gabriela Poles. This publication’s contents are solely the responsibility of the authors and do not necessarily represent the views of the aforementioned organizations. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Harvard University Center for AIDS Research (CFAR) supported and funded the study through National Institutes of Health (NIH) funded program (P30AI060354), as well as the Doris Duke Charitable Foundation to Harvard University funded Clinical Research Fellow Gabriela Poles.

PY - 2014/1

Y1 - 2014/1

N2 - Health system responsiveness (HSR), a measure of patient health care experience, may influence adherence to HIV/AIDS care and be an important predictor of outcomes. We studied the relationship between HSR, patient factors, and visit nonadherence in 16 President's Emergency Plan for AIDS Relief-supported HIV/AIDS clinics in Dar es Salaam. An HSR survey was administered in 2009, and all clinic visits 1 year following the interviews were analyzed for 720 patients on antiretrovirals (ARVs). Definitions of visit nonadherence were (1) low visit constancy ([VC], no visit in ≥1 quarter), (2) gaps in care (>60 days between visits), (3) no visit in last quarter (VLQ). The relationships between factors were analyzed using multivariate analysis with adjusted odds ratio (AOR) and 95% confidence intervals (CI) reported. Few patients were nonadherent using VLQ (14%) and VC (28%). Gaps in care were more common (49.6%) and associated with younger age (AOR: 3.86 [2.02-7.40]), no explanation of side effects (AOR: 2.21 [1.49-3.28]), and shorter antiretroviral therapy (ART) duration (0-3 months AOR: 1.49 [1.09-2.03]; 3-6 months AOR: 2.44 [1.40-4.25]). No VLQ was associated with younger age (AOR: 3.40 [1.63-7.07]), poor health care worker (HCW) communication (AOR: 4.83 [1.39-16.78]), and less time on ART (0-3 months AOR: 5.04 [2.47-10.30]; 3-6 months AOR: 3.09 [1.72-5.57]). Younger age, poor HCW communication, and shorter ART duration also predicted lower VC, as did higher patient-HCW ratios. The rates of visit nonadherence differed based on the definitions used. Younger age, shorter time on ART, and poor HCW communication predicted lower adherence regardless of the definition. More work is needed to understand the relationship between HSR, patient factors, and different patterns of visit nonadherence and their impact on ART outcomes.

AB - Health system responsiveness (HSR), a measure of patient health care experience, may influence adherence to HIV/AIDS care and be an important predictor of outcomes. We studied the relationship between HSR, patient factors, and visit nonadherence in 16 President's Emergency Plan for AIDS Relief-supported HIV/AIDS clinics in Dar es Salaam. An HSR survey was administered in 2009, and all clinic visits 1 year following the interviews were analyzed for 720 patients on antiretrovirals (ARVs). Definitions of visit nonadherence were (1) low visit constancy ([VC], no visit in ≥1 quarter), (2) gaps in care (>60 days between visits), (3) no visit in last quarter (VLQ). The relationships between factors were analyzed using multivariate analysis with adjusted odds ratio (AOR) and 95% confidence intervals (CI) reported. Few patients were nonadherent using VLQ (14%) and VC (28%). Gaps in care were more common (49.6%) and associated with younger age (AOR: 3.86 [2.02-7.40]), no explanation of side effects (AOR: 2.21 [1.49-3.28]), and shorter antiretroviral therapy (ART) duration (0-3 months AOR: 1.49 [1.09-2.03]; 3-6 months AOR: 2.44 [1.40-4.25]). No VLQ was associated with younger age (AOR: 3.40 [1.63-7.07]), poor health care worker (HCW) communication (AOR: 4.83 [1.39-16.78]), and less time on ART (0-3 months AOR: 5.04 [2.47-10.30]; 3-6 months AOR: 3.09 [1.72-5.57]). Younger age, poor HCW communication, and shorter ART duration also predicted lower VC, as did higher patient-HCW ratios. The rates of visit nonadherence differed based on the definitions used. Younger age, shorter time on ART, and poor HCW communication predicted lower adherence regardless of the definition. More work is needed to understand the relationship between HSR, patient factors, and different patterns of visit nonadherence and their impact on ART outcomes.

KW - HIV/AIDS

KW - adherence

KW - health systems responsiveness

KW - patient satisfaction

KW - resource-limited settings

UR - http://www.scopus.com/inward/record.url?scp=84893099053&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84893099053&partnerID=8YFLogxK

U2 - 10.1177/1545109712467068

DO - 10.1177/1545109712467068

M3 - Article

C2 - 23269515

AN - SCOPUS:84893099053

SN - 2325-9574

VL - 13

SP - 78

EP - 84

JO - Journal of the International Association of Providers of AIDS Care

JF - Journal of the International Association of Providers of AIDS Care

IS - 1

ER -

Factors associated with different patterns of nonadherence to HIV care in dar es salaam, Tanzania

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this