Factors Associated with Different Patterns of Nonadherence to HIV Care in Dar es Salaam, Tanzania

Health system responsiveness (HSR), a measure of patient health care experience, may influence adherence to HIV/AIDS care and be an important predictor of outcomes. We studied the relationship between HSR, patient factors, and visit nonadherence in 16 President's Emergency Plan for AIDS Relief–supported HIV/AIDS clinics in Dar es Salaam. An HSR survey was administered in 2009, and all clinic visits 1 year following the interviews were analyzed for 720 patients on antiretrovirals (ARVs). Definitions of visit nonadherence were (1) low visit constancy ([VC], no visit in ≥1 quarter), (2) gaps in care (>60 days between visits), (3) no visit in last quarter (VLQ). The relationships between factors were analyzed using multivariate analysis with adjusted odds ratio (AOR) and 95% confidence intervals (CI) reported. Few patients were nonadherent using VLQ (14%) and VC (28%). Gaps in care were more common (49.6%) and associated with younger age (AOR: 3.86 [2.02-7.40]), no explanation of side effects (AOR: 2.21 [1.49-3.28]), and shorter antiretroviral therapy (ART) duration (0-3 months AOR: 1.49 [1.09-2.03]; 3-6 months AOR: 2.44 [1.40-4.25]). No VLQ was associated with younger age (AOR: 3.40 [1.63-7.07]), poor health care worker (HCW) communication (AOR: 4.83 [1.39-16.78]), and less time on ART (0-3 months AOR: 5.04 [2.47-10.30]; 3-6 months AOR: 3.09 [1.72-5.57]). Younger age, poor HCW communication, and shorter ART duration also predicted lower VC, as did higher patient-HCW ...
Source: Journal of the International Association of Physicians in AIDS Care (JIAPAC) - Category: Infectious Diseases Authors: Tags: Antiretroviral Therapy Source Type: research