Determinants of Engagement in HIV Treatment and Care Among Zambians New to Antiretroviral Therapy

Jones, Deborah L.; Zulu, Isaac; Vamos, Szonja; Cook, Ryan; Chitalu, Ndashi; Weiss, Stephen M.

doi:10.1016/j.jana.2012.06.009

Cited by 22 publications

(46 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Routines and procedures at the study clinic seemed to affect retention if they induced concerns about stigma, as has been reported in other settings [ 45 ], suggesting that care providers could reduce LTFU with greater sensitivity to privacy and procedures that differentiate HIV patients from others [ 45 ]. Similarly, lack of continuity in care, non-responsive care, and inappropriate treatment discourage patients from remaining in care, as others have also reported [ 42 , 43 , 46 , 47 ]. Evidence suggests that patient-centered positive interactions promote engagement in care, improving treatment outcomes [ 48 – 50 ].…”

Section: Discussionmentioning

confidence: 99%

Retention in Care among HIV-Infected Adults in Ethiopia, 2005– 2011: A Mixed-Methods Study

et al. 2016

View full text Add to dashboard Cite

BackgroundPoor retention in HIV care challenges the success of antiretroviral therapy (ART). This study assessed how well patients stay in care and explored factors associated with retention in the context of an initial ART rollout in Sub-Saharan Africa.MethodsWe conducted a mixed-methods study at a teaching hospital in Addis Ababa, Ethiopia. A cohort of 385 patients was followed for a median of 4.6 years from ART initiation to lost-to-follow-up (LTFU—missing appointments for more than three months after last scheduled visit or administrative censoring). We used Kaplan-Meier plots to describe LTFU over time and Cox-regression models to identify factors associated with being LTFU. We held six focus group discussions, each with 6–11 patients enrolled in care; we analyzed data inductively informed by grounded theory.ResultsPatients in the cohort were predominantly female (64%) and the median age was 34 years. Thirty percent were LTFU by study’s end; the median time to LTFU was 1,675 days. Higher risk of LTFU was associated with baseline CD4 counts <100 and >200 cells/μL (HR = 1.62; 95% CI:1.03–2.55; and HR = 2.06; 95% CI:1.15–3.70, respectively), compared with patients with baseline CD4 counts of 100–200 cells/μL. Bedridden participants at ART initiation (HR = 2.05; 95% CIs [1.11–3.80]) and those with no or only primary education (HR = 1.50; 95% CIs [1.00–2.24]) were more likely to be LTFU. Our qualitative data revealed that fear of stigma, care dissatisfaction, use of holy water, and economic constraints discouraged retention in care. Social support and restored health and functional ability motivated retention.ConclusionComplex socio-cultural, economic, and health-system factors inhibit optimum patient retention. Better tracking, enhanced social support, and regular adherence counseling addressing stigma and alternative healing options are needed. Intervention strategies aimed at changing clinic routines and improving patient–provider communication could address many of the identified barriers.

show abstract

Section: Discussionmentioning

confidence: 99%

Retention in Care among HIV-Infected Adults in Ethiopia, 2005– 2011: A Mixed-Methods Study

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Currently, studies have not explored the relationship between depression, cognitive impairment, and response to an intervention to improve adherence in India. Additionally, although cognitive-behavioral interventions have been utilized to promote a number of positive health outcomes in a variety of settings (Brown & Vanable, 2008 ; Jones et al, 2013 ; Safren et al, 2009 ), cognitive-behavioral interventions have not been utilized to enhance adherence in India.…”

Section: Introductionmentioning

confidence: 99%

Cognitive functioning, depression, and HIV medication adherence in India: a randomized pilot trial

Cook

Waldrop‐Valverde

Sharma

et al. 2014

Health Psychology and Behavioral Medicine

Self Cite

View full text Add to dashboard Cite

Objective: India is home to the third-largest number of people living with HIV in the world, and no-cost antiretroviral therapy (ART) has been available across the country since 2004. However, rates of adherence to ART are often subpar in India, and interventions to increase adherence are warranted. Cognitive impairment and depression have been associated with ART non-adherence, and may also limit the impact of behavioral interventions designed to improve adherence. Studies have not evaluated the impact of cognitive impairment and depression on response to adherence interventions in India. Methods: Individuals new to ART (≤12 months prescribed) were recruited from a public hospital in Chandigarh, India. Participants (N = 80) were randomized to either a group medication adherence intervention (MAI) or an enhanced standard of care (ESOC) condition. The MAI consisted of three monthly gender-concordant group cognitive-behavioral sessions addressing HIV and ART, adherence, and HIV-related coping and social support. Participants were assessed at baseline for depression and cognitive functioning, and assessed monthly for adherence by pill count. Results: Adherence among participants receiving the MAI improved by about one day's dose over the course of the study, and no improvement was noted among those in the ESOC. Additionally, high rates of cognitive impairment (57%) and depression (25%) were identified among participants. There was no evidence that cognitive impairment moderated response to the intervention. However, while non-depressed participants benefitted from the intervention, depressed participants failed to show the same improvement. Conclusions: Results of this pilot study suggest that group behavioral interventions can be an effective strategy to promote ART adherence in this population, even among those demonstrating cognitive impairment. However, because of the negative impact of depression on adherence, future studies should continue to develop strategies to identify and treat it among people living with HIV in India.

show abstract

“…All study materials were adapted for the local setting collaboratively using interviews and focus groups (Arístegui et al, 2014; Bofill et al, 2014). The patient interventions were adapted from the team’s prior studies targeting engagement and adherence (Jones et al, 2013; Jones, Zulu, Vamos, Cook, Chitalu, & Weiss, 2013; Peltzer, Jones, Weiss, & Shikwane, 2011) and utilized the Information-Motivation-Behavioral (IMB) skills model (Fisher, Amico, Fisher, & Harman, 2008; Fisher, Fisher, Amico, & Harmann, 2006). Both interventions were tailored utilizing previous research (Valverde et al, 2009) and site visits conducted prior to intervention adaptation.…”

Section: Methodsmentioning

confidence: 99%

Implementation and uptake of the Conexiones y Opciones en la Argentina intervention: feasibility and acceptability

et al. 2016

Self Cite

View full text Add to dashboard Cite

Challenging HIV-infected patients, those neither adherent nor actively engaged in care, represent an important opportunity for intervention if the HIV epidemic is to be contained. This pilot study assessed the feasibility and acceptability of an adapted patient adherence intervention and a motivational interviewing-based provider intervention in urban Buenos Aires, Argentina, in order to optimize health benefits in challenging HIV-infected patients. To maximize implementation and uptake of both strategies, interventions were adapted to the local setting. Qualitative data and a short quantitative assessment from patients, staff, fellows, residents and physicians (n = 84) were examined to establish the feasibility and acceptability of offering patient and provider evidence-based interventions in both public and private healthcare settings. Results identified key themes on provision of information, use of specialized communication techniques, and group support in the utilization of the interventions. Both providers (n = 12) and patients (n = 120) endorsed the acceptability and value of the interventions, and the feasibility of their delivery. Findings support the use of both intervention modalities with challenging patients in diverse urban healthcare settings.

show abstract

Determinants of Engagement in HIV Treatment and Care Among Zambians New to Antiretroviral Therapy

Cited by 22 publications

References 30 publications

Retention in Care among HIV-Infected Adults in Ethiopia, 2005– 2011: A Mixed-Methods Study

Retention in Care among HIV-Infected Adults in Ethiopia, 2005– 2011: A Mixed-Methods Study

Cognitive functioning, depression, and HIV medication adherence in India: a randomized pilot trial

Implementation and uptake of the Conexiones y Opciones en la Argentina intervention: feasibility and acceptability

Contact Info

Product

Resources

About