Clinic Attendance for Medication Refills and Medication Adherence amongst an Antiretroviral Treatment Cohort in Uganda: A Prospective Study

Abstract

Background. Regular clinic attendance for antiretroviral (ARV) drug refills is important for successful clinical outcomes in HIV management. Methods. Clinic attendance for ARV drug refills and medication adherence using a clinic-based pill count in 392 adult patients receiving antiretroviral therapy (ART) in a district hospital in Uganda were prospectively monitored over a 28-week period. Results. Of the 2267 total scheduled clinic visits, 40 (1.8%) were missed visits. Among the 392 clients, 361 (92%) attended all appointments for their refills (regular attendance). Clinic attendance for refills was statistically significantly associated with medication adherence with regular attendant clients having about fourfold greater odds of achieving optimal (≥95%) medication adherence [odds ratio (OR) = 3.89, 95% CI: 1.48 to 10.25, exact P = .013]. In multivariate analysis, clients in age category 35 years and below were less likely to achieve regular clinic attendance. Conclusion. Monitoring of clinic attendance may be an objective and effective measure and could be a useful adjunct to an adherence measure such as pill counting in resource-constrained settings. Where human resource constraints do not allow pill counts or other time-consuming measures, then monitoring clinic attendance and acting on missed appointments may be an effective proxy measure.

The relationship between adherence to clinic appointments and year-one mortality for newly enrolled HIV infected patients at a regional referral hospital in Western Kenya, January 2011–December 2012

“…Although close to half of the patients were defaulters, they only accounted for 9% of the missed scheduled appointments. As observed in the published literature, this could be explained by the number of scheduled appointments at HIV clinics (an average of 10 annual visits), which were all kept by the non-defaulting patients and defaulters only missing a proportion of their scheduled appointments (Kunutsor et al, 2010). …”

Household Food Insecurity Associated With Antiretroviral Therapy Adherence Among HIV-Infected Patients in Windhoek, Namibia

“…Third, our participants were recruited while at their routine clinic visit, which may not accurately represent all participants on ART, representing a selection bias. Those who attend their routine clinic visits are more likely to be adherent to medication and have less household food insecurity than patients who miss their clinic visits [52]. This selection bias would be expected to bias our results towards the null.…”

Facility-level intervention to improve attendance and adherence among patients on anti-retroviral treatment in Kenya—a quasi-experimental study using time series analysis

“…Patients need to attend appointments consistently to manage clinical issues related to ART and to avoid gaps in therapy [3], and coming to the clinic regularly has been significantly associated with optimum medication adherence [19]. Patients’ failure to attend the clinic when expected is an objective indicator that is easy to ascertain [9]; inconsistent attendance can identify patients requiring more focused interventions such as adherence counselling or outreach [16].…”