Clinic Attendance for Antiretroviral Pills Pick-Up among HIV-Positive People in Nepal: Roles of Perceived Family Support and Associated Factors

Abstract

IntroductionHIV-positive people’s clinic attendance for medication pick-up is critical for successful HIV treatment. However, limited evidence exists on it especially in low-income settings such as Nepal. Moreover, the role of family support in clinic attendance remains under-explored. Therefore, this study was conducted to examine the association between perceived family support and regular clinic attendance and to assess factors associated with regular clinic attendance for antiretroviral pills pick-up among HIV-positive individuals in Nepal.MethodsA cross-sectional study was conducted among 423 HIV-positive people in three districts of Nepal. Clinic attendance was assessed retrospectively for the period of 12 months. To assess the factors associated, an interview survey was conducted using a semi-structured questionnaire from July to August, 2015. Multiple logistic regression models were used to assess the factors associated with regular clinic attendance.ResultsOf 423 HIV-positive people, only 32.6% attended the clinics regularly. They were more likely to attend them regularly when they received high family support (AOR = 3.98, 95% CI = 2.29, 6.92), participated in support programs (AOR = 1.68, 95% CI = 1.00, 2.82), and had knowledge on the benefits of antiretroviral therapy (AOR = 2.62, 95% CI = 1.15, 5.99). In contrast, they were less likely to attend them regularly when they commuted more than 60 minutes to the clinics (AOR = 0.53, 95% CI = 0.30, 0.93), when they self-rated their health status as being very good (AOR = 0.13, 95% CI = 0.04, 0.44), good (AOR = 0.14, 95% CI = 0.04, 0.46), and fair (AOR = 0.21, 95% CI = 0.06, 0.70).ConclusionHIV-positive individuals are more likely to attend the clinics regularly when they receive high family support, know the benefits of antiretroviral therapy, and participate in support programs. To improve clinic attendance, family support should be incorporated with HIV care programs in resource limited settings. Service providers should also consider educating them about the benefits of antiretroviral therapy.

Virological failure among adolescents on ART, Harare City, 2017- a case-control study

“…Ayer et al, 2016 also found that belonging to a support group was associated with viral suppression [23]. Our study also demonstrated that older adolescents were more likely to develop virological failure as compared to the younger adolescents.…”

Sociodemographic profile and predictors of outpatient clinic attendance among HIV-positive patients initiating antiretroviral therapy in Selangor, Malaysia

“… 37 It is possible that the well-documented vulnerabilities, stigma, and discrimination often associated with HIV positivity status, particularly among females, might have influenced their clinic attendance behavior in this study. That said, our study provides further evidence to support previous reports 16 , 17 , 19 that gender is not a significant predictor of outpatient clinic attendance among HIV-positive patients receiving ART. Of several similar studies conducted around the world in the past decade, only a Chinese national study of 27,504 patients receiving ART reported female gender as being significantly associated with higher likelihood of early missed visits.…”

“…With the exception of one study conducted in Uganda, 13 studies conducted in United States, South America, Africa, and Asia among HIV-positive patients attending outpatient clinics have consistently reported prevalence rates of missed appointment above 20%. 5 , 14 , 17 , 19 , 20 , 36 The lower prevalence (18.7%) reported in this study is probably partly due to the fact that half of the respondents in this study had received SMS and telephone call reminders for their scheduled clinic appointments throughout the study period. In addition, it is important to note that ours was a cohort initiating ART, and therefore has possibly higher than normal attendance rates.…”

“…Irrespective of the specific purpose of a scheduled outpatient clinic visit – be it for clinical evaluation, laboratory investigations, or drug refill – missed appointments often result in poor outcomes for patients receiving ART. In fact, poor adherence to drug refill or pickup has been proven to be a strong EWI of virologic and immunologic failure 19 , 35 and predictor of medication adherence 13 among HIV-positive patients on ART.…”

“… 18 More often than not, system-level factors such as adherence counseling, hospital-based support group, and high family support have been more consistently associated with regular clinic attendance among HIV-positive patients receiving ART in Asia. 19 , 20 Provider-level factors such as availability, attitude, and communication styles of HIV clinicians and other health care team members have also been reported to influence clinic attendance. 21 …”