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

Abstract

BackgroundInconsistent literature evidence suggests that sociodemographic, economic, and system- and patient-related factors are associated with clinic attendance among the HIV-positive population receiving antiretroviral therapy (ART) around the world. We examined the factors that predict outpatient clinic attendance among a cohort of HIV-positive patients initiating ART in Selangor, Malaysia.Patients and methodsThis cross-sectional study analyzed secondary data on outpatient clinic attendance and sociodemographic, economic, psychosocial, and patient-related factors among 242 adult Malaysian patients initiating ART in Selangor, Malaysia. Study cohort was enrolled in a parent randomized controlled trial (RCT) in Hospital Sungai Buloh Malaysia between January and December 2014, during which peer counseling, medication, and clinic appointment reminders were provided to the intervention group through short message service (SMS) and telephone calls for 24 consecutive weeks. Data on outpatient clinic attendance were extracted from the hospital electronic medical records system, while other patient-level data were extracted from pre-validated Adult AIDS Clinical Trial Group (AACTG) adherence questionnaires in which primary data were collected. Outpatient clinic attendance was categorized into binary outcome – regular attendee and defaulter categories – based on the number of missed scheduled outpatient clinic appointments within a 6-month period. Multivariate regression models were fitted to examine predictors of outpatient clinic attendance using SPSS version 22 and R software.ResultsA total of 224 (93%) patients who completed 6-month assessment were included in the model. Out of those, 42 (18.7%) defaulted scheduled clinic attendance at least once. Missed appointments were significantly more prevalent among females (n=10, 37.0%), rural residents (n=10, 38.5%), and bisexual respondents (n=8, 47.1%). Multivariate binary logistic regression analysis showed that Indian ethnicity (adjusted odds ratio [AOR] =0.235; 95% CI [0.063–0.869]; P=0.030) and heterosexual orientation (AOR =4.199; 95% CI [1.040–16.957]; P=0.044) were significant predictors of outpatient clinic attendance among HIV-positive patients receiving ART in Malaysia.ConclusionEthnicity and sexual orientation of Malaysian patients may play a significant role in their level of adherence to scheduled clinic appointments. These factors should be considered during collaborative adherence strategy planning at ART initiation.

On-Time Appointment Keeping and Associated Factors among Human Immunodeficiency Virus-Positive Adult Patients Accessing Antiretroviral Therapy at Health Centers in East Gojjam Zone, Northwest Ethiopia, 2019

“…Tis fnding is lower than those of the studies conducted in East Africa, at 75.8% [19], Cambodia at 79.6% [20], Florida at 72.1% [21], and Malaysia at 81.3% [15]. Adult HIV patients often struggle with attendance at medical appointments due to various factors including work and childcare demands, lack of medical comorbidities, transportation issues, substance abuse, and untreated mental health conditions [22].…”

“…Appointment keeping can be easily accessed from attendance records. If a patient has been visiting within seven days of all scheduled clinic appointments for 12 months, or within 24-48 hours before the "original" scheduled appointment [15], it is scored as 1 (yes); if a person has missed one or more scheduled clinic appointments for any reason(s), it is scored as 0 (no) [16]. Tis study did not consider unscheduled visits to an emergency room, an inpatient ward, or any ward [15].…”

“…If a patient has been visiting within seven days of all scheduled clinic appointments for 12 months, or within 24-48 hours before the "original" scheduled appointment [15], it is scored as 1 (yes); if a person has missed one or more scheduled clinic appointments for any reason(s), it is scored as 0 (no) [16]. Tis study did not consider unscheduled visits to an emergency room, an inpatient ward, or any ward [15]. Independent variables were sociodemographic (such as sex, age, residence, educational status, occupation, marital status, and monthly income), healthcare delivery systems (such as paper-based appointments, follow-up counseling, ever-faced unavailability of health workers, appointment time convenience, and satisfaction), patient-related, psychosocial (Appendix 3), and clinical-related factors (Appendix 2).…”

A Systematic Literature Review on Online Medical Services in Malaysia

“…Literature from the year 2014 to 2018 also explores the very hot and sensitive diseases like HIV positive and cancer patients. Abdulrahman et al, [18] study highlighted the sociodemographic profile and predictors of outpatient visits of Malaysian antiretroviral therapy patients. The main idea is conveying and delivers mobile messages and reminders about the important dates and timing for therapy attendance.…”

“…HIV positive patients need strict medication adherence and regular clinic appointments schedule. Like the other chronic diseases, continuous visits to the clinic, medication refill, laboratory tests and clinic treatments are prior to achieving the success and good clinical results [18]. Researchers are focusing to conceptualize the efficient assistance to HIV positive patients.…”