Examining Adherence Among Challenging Patients in Public and Private HIV Care in Argentina

Jones, Deborah L.; Cook, Ryan; Cecchini, Diego; Sued, Omar; Bofill, Lina; Waldrop‐Valverde, Drenna; López, María Fernanda; Spence, Andrew

doi:10.1007/s10461-015-1037-7

Cited by 15 publications

(15 citation statements)

References 25 publications

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“…Patient level factors that contribute to defaulting from ART include forgetfulness [4] fatigue, hopelessness [5], absence of symptoms and severity of the illness [6–8]. Furthermore, lack of support from a partner [6, 7] negative perceptions towards ART medication, pre-occupation [3, 9, 10] and absence from home due to employment [4] compromises adherence to ARVs.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing adherence to antiretroviral treatment among adults accessing care from private health facilities in Malawi

et al. 2019

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BackgroundPrivate health facilities are increasingly being recognized as the neglected partner in the provision of HIV services. The non-adherence rate in the study sites ranged from 19 to 22%. This study explored the factors associated with non-adherence from antiretroviral therapy (ART) among adult patients accessing ART services at two privately owned urban health facilities in Malawi.MethodsWe conducted a descriptive qualitative approach employing in-depth interviews among adults who either defaulted or were retained in HIV care in two privately owned facilities in Malawi from March to July 2017. We purposively selected participants and interviewed a total of 6 ART providers and 24 ART clients. Data were analyzed manually using a thematic approach.ResultsOverall, participants identified four facilitators for retention in care and four broad categories of barriers namely individual, psychological, drug related and human resource related factors. The factors that facilitated retention in care included follow up visits after missing a visit, adequate information education and counseling, and supportive relationships.ConclusionThe main reason for defaulting from antiretrovirals (ARVs) was fear of disclosing an HIV status to avert potential stigma and discrimination. In implementing ART clinics due consideration and strategies need to be adopted to ensure that privacy and confidentiality is preserved. Although adoption of all the key Malawi Implementing strategies like expert clients and a guardian may optimize retention in care, there is need for prior analysis of how those may lead to unintended disclosure which inadvertently affects adherence. Furthermore, private facilities should orient their clients to the public facilities within the catchment area so that clients have an option for alternative access to HIV care in the event of financial constraints.

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Section: Introductionmentioning

confidence: 99%

Factors influencing adherence to antiretroviral treatment among adults accessing care from private health facilities in Malawi

et al. 2019

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“…Nevertheless, variables and factors connected to the socio-economic and the healthcare architecture certainly impact greatly on the level of medication adherence. Having a public or a private NHS system, or drug insurance or easy access to treatment, make an important difference in terms of medication adherence rate [ 56 , 57 ]. For example, Seth A. Seabury et al (2015) [ 58 ] investigated the association between plan-level measures of health outcomes and medication adherence to assess the viability of adherence as a measure of plan performance, finding that plan-level averages of medication adherence were associated with lower rates of disease-related complications.…”

Section: Resultsmentioning

confidence: 99%

Scoping review and bibliometric analysis of Big Data applications for Medication adherence: an explorative methodological study to enhance consistency in literature

Pirri

Lorenzoni

Turchetti

2020

BMC Health Serv Res

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Background: Medication adherence has been studied in different settings, with different approaches, and applying different methodologies. Nevertheless, our knowledge and efficacy are quite limited in terms of measuring and evaluating all the variables and components that affect the management of medication adherence regimes as a complex phenomenon. The study aim is mapping the state-of-the-art of medication adherence measurement and assessment methods applied in chronic conditions. Specifically, we are interested in what methods and assessment procedures are currently used to tackle medication adherence. We explore whether Big Data techniques are adopted to improve decision-making procedures regarding patients' adherence, and the possible role of digital technologies in supporting interventions for improving patient adherence and avoiding waste or harm. Methods: A scoping literature review and bibliometric analysis were used. Arksey and O'Malley's framework was adopted to scope the review process, and a bibliometric analysis was applied to observe the evolution of the scientific literature and identify specific characteristics of the related knowledge domain. Results: A total of 533 articles were retrieved from the Scopus academic database and selected for the bibliometric analysis. Sixty-one studies were identified and included in the final analysis. The Morisky medication adherence scale (36%) was the most frequently adopted baseline measurement tool, and cardiovascular/hypertension disease, the most investigated illness (38%). Heterogeneous findings emerged from the types of study design and the statistical methodologies used to assess and compare the results. Conclusions: Our findings reveal a lack of Big Data applications currently deployed to address or measure medication adherence in chronic conditions. Our study proposes a general framework to select the methods, measurements and the corpus of variables in which the treatment regime can be analyzed.

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“…In Argentina, 31% of men and 23% of women entered care late [ 5 ]; in Chile, 80% of patients; and in Peru, 40% [ 4 , 37 ]. Many HIV-infected patients in Argentina have reported that they are unsure of the potential impact of non-adherence [ 42 , 44 ], and expressed concern with antiretroviral (ARV) side effects [ 42 ] and their impact on social relationships [ 44 , 45 ]. Feelings of ambivalence, weariness and anxiety about ART often lead to non-adherence and medication discontinuation [ 42 ].…”

Section: Methodsmentioning

confidence: 99%

Physician-delivered motivational interviewing to improve adherence and retention in care among challenging HIV-infected patients in Argentina (COPA2): study protocol for a cluster randomized controlled trial

Sued

Cassetti

Cecchini

et al. 2018

Trials

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Background“Challenging” HIV-infected patients, those not retained in treatment, represent a critical focus for positive prevention, as linkage to care, early initiation of antiretroviral therapy, adherence and retention in treatment facilitate viral suppression, thus optimizing health and reducing HIV transmission. Argentina was one of the first Latin American countries to guarantee HIV prevention, diagnosis and comprehensive care services, including antiretroviral medication, which removed cost and access as barriers. Yet, dropout occurs at every stage of the HIV continuum. An estimated 110,000 individuals are HIV-infected in Argentina; of these, 70% have been diagnosed and 54% were linked to care. However, only 36% have achieved viral suppression and 31% of those diagnosed delayed entry to care. To achieve meaningful reductions in HIV infection at the community level, innovative strategies must be developed to re-engage patients. Motivational Interviewing (MI) is a patient-centered approach and has been used by therapists in Central and South America to enhance motivation and commitment in substance use and risk reduction. Our pilot feasibility study utilized culturally tailored MI in physicians to target patients not retained in treatment in public and private clinics in Buenos Aires, Argentina. Results demonstrated that a physician-based MI intervention was feasible and effective in enhanced and sustained patient adherence, viral suppression, and patient-physician communication and attitudes about treatment among these patients at 6 and 9 months post baseline.Methods/designThis clinical trial seeks to extend these findings in public and private clinics in four urban population centers in Argentina, in which clinics (n = 6 clinics, six MDs per clinic site) are randomized to experimental (physician MI Intervention) (n = 3) or control (physician Standard of Care) (n = 3) conditions in a 3:3 ratio. Using a cluster randomized clinical trial design, the study will test the effectiveness of a physician-based MI intervention to improve and sustain retention, adherence, persistence, and viral suppression among “challenging” patients (n = 420) over 24 months.DiscussionResults are anticipated to have significant public health implications for the implementation of MI to re-engage and retain patients in HIV treatment and care and improve viral suppression through high levels of medication adherence.Trial registrationClinicalTrials.gov, ID: NCT02846350. Registered on 1 July 2016.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2758-5) contains supplementary material, which is available to authorized users.

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Examining Adherence Among Challenging Patients in Public and Private HIV Care in Argentina

Cited by 15 publications

References 25 publications

Factors influencing adherence to antiretroviral treatment among adults accessing care from private health facilities in Malawi

Factors influencing adherence to antiretroviral treatment among adults accessing care from private health facilities in Malawi

Scoping review and bibliometric analysis of Big Data applications for Medication adherence: an explorative methodological study to enhance consistency in literature

Physician-delivered motivational interviewing to improve adherence and retention in care among challenging HIV-infected patients in Argentina (COPA2): study protocol for a cluster randomized controlled trial

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