A model to predict adherence to antiretroviral therapy among people living with HIV

2021 ◽  
pp. sextrans-2021-055222
Author(s):  
Hui Chen ◽  
Rusi Long ◽  
Tian Hu ◽  
Yaqi Chen ◽  
Rongxi Wang ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Treatment ◽  
Poor Adherence ◽  
People Living With Hiv ◽  
Art Adherence ◽  
Snowball Sampling ◽  
Hiv Viral Load ◽  
Temporal Validation ◽  
Suboptimal Adherence ◽  
Living With Hiv

ObjectivesSuboptimal adherence to antiretroviral therapy (ART) dramatically hampers the achievement of the UNAIDS HIV treatment targets. This study aimed to develop a theory-informed predictive model for ART adherence based on data from Chinese.MethodsA cross-sectional study was conducted in Shenzhen, China, in December 2020. Participants were recruited through snowball sampling, completing a survey that included sociodemographic characteristics, HIV clinical information, Information-Motivation-Behavioural Skills (IMB) constructs and adherence to ART. CD4 counts and HIV viral load were extracted from medical records. A model to predict ART adherence was developed from a multivariable logistic regression with significant predictors selected by Least Absolute Shrinkage and Selection Operator (LASSO) regression. To evaluate the performance of the model, we tested the discriminatory capacity using the concordance index (C-index) and calibration accuracy using the Hosmer and Lemeshow test.ResultsThe average age of the 651 people living with HIV (PLHIV) in the training group was 34.1±8.4 years, with 20.1% reporting suboptimal adherence. The mean age of the 276 PLHIV in the validation group was 33.9±8.2 years, and the prevalence of poor adherence was 22.1%. The suboptimal adherence model incorporates five predictors: education level, alcohol use, side effects, objective abilities and self-efficacy. Constructed by those predictors, the model showed a C-index of 0.739 (95% CI 0.703 to 0.772) in internal validation, which was confirmed be 0.717 via bootstrapping validation and remained modest in temporal validation (C-index 0.676). The calibration capacity was acceptable both in the training and in the validation groups (p>0.05).ConclusionsOur model accurately estimates ART adherence behaviours. The prediction tool can help identify individuals at greater risk for poor adherence and guide tailored interventions to optimise adherence.

scholarly journals Global burden of active smoking among people living with HIV on antiretroviral therapy: a systematic review and meta-analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Boni Maxime Ale ◽  
Franck Amahowe ◽  
Motto Malea Nganda ◽  
Célestin Danwang ◽  
Nelly Njeri Wakaba ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Southern Africa ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Art Adherence ◽  
Active Smoking ◽  
Suboptimal Adherence ◽  
Sub Saharan ◽  
Eastern And Southern Africa ◽  
Living With Hiv

Abstract Background Although the high burden of both active smoking and human immunodeficiency virus (HIV) is clearly known, the relationship between them is still not well characterized. Therefore, we estimated the global prevalence of active smoking in people living with HIV (PLHIV) on antiretroviral therapy (ART) and investigated the association between exposure to active smoking and risk for suboptimal adherence to ART. Main text: We searched PubMed, Embase, and Web of Science to identify articles published until September 19, 2019. Eligible studies reported the prevalence of active smoking in PLHIV on ART or investigated the association between active smoking and ART adherence; or enough data to compute these estimates. We used a random-effects model to pool data and quantified heterogeneity (I2). The global prevalence of active smoking was 36.1% (95% CI: 33.7–37.2; 329 prevalence data; 462 104 participants) with substantial heterogeneity. The prevalence increased with level of country income; from 10.1% (95% CI: 6.8–14.1) in low-income to 45.2% (95% CI: 42.7–47.7) in high-income countries; P < 0.0001. With regards to the Joint United Nations Programme on HIV/AIDS (UNAIDS) regions, the prevalence was higher in West and Central Europe and North America 45.4% (42.7–48.1) and lowest in the two UNAIDS regions of sub-Saharan Africa: Eastern and Southern Africa 10.7% (95% CI: 7.8–14.0) and West and Central Africa 4.4% (2.9–6.3); P < 0.0001. Globally, we estimated that there were 4 110 669 PLHIV on ART who were active smokers, among which the highest number was from Eastern and Southern Africa (35.9%) followed by Asia and the Pacific (25.9%). Active smoking was significantly associated with suboptimal ART adherence: pooled odds ratio 1.57 (95% CI: 1.37–1.80; I2 = 56.8%; 19 studies; 48 450 participants); even after considering adjusted estimates: 1.67 (95% CI: 1.39–2.01; I2 = 53.0%; 14 studies). Conclusions This study suggests a high prevalence of active smoking in PLHIV on ART and an association between active smoking and ART suboptimal adherence. As such, healthcare providers and policy makers should focus on adopting and implementing tobacco harm reduction strategies in HIV care, especially in sub-Saharan Africa known as epicenter of HIV pandemic with highest number of active tobacco smoking among PLHIV on ART.

Barriers to antiretroviral therapy adherence among prisoners in one prison in Iran

2019 ◽  
Vol 19 ◽  
Author(s):  
Behnam Farhoudi ◽  
Seyed Ahmad Seyedalinaghi ◽  
Masoud Jafarinasab ◽  
Seyed Mohammad Ghavam ◽  
Omid Dadras ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Patient Adherence ◽  
Social Stigma ◽  
Group Discussion ◽  
Life Quality ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Dramatic Improvement ◽  
Art Adherence ◽  
Opium Addiction

Background: Antiretroviral medications have improved the survival and life quality of people living with HIV and turned HIV into a chronic controllable disease. However, the success of HIV treatment depends on many factors; the patient adherence is one the most important indicators which. In this study, we explored the potential barriers to an effective adherence antiretroviral therapy (ART) among the HIV-positive prisoners of Ghezelhesar prison, Iran. Methods: To explore and identify the barriers toward ART adherence, a focus group discussion was held with six prisoners eligible for ART but rejected to be treated or did not retain on ART. The prisoners were recruited through purposive sampling method. All the words, behaviors and even body languages were precisely recorded and analyzed to reach the final results. Results: The most reported obstacles toward ART adherence were the lack of trust in effectiveness of medications and drug complications. Other reasons were inadequate nutrition, lack of amenities, social stigma, lack of economic and psychological support, misbehavior of prison staff and inadequate methadone prescription for those with opium addiction. Conclusion: Due to the results and the fact that adequate Methadone prescription for opium addiction, improving life quality and receiving emotional and medical support from staff could improve adherence to HIV medication in prisoners, comprehensive education of prisoners about their health condition along with staff education may improve the life condition of HIV infected prisoners and may cause dramatic improvement in ART adherence and prisoners health.

scholarly journals Symptoms of common mental disorders and adherence to antiretroviral therapy among adults living with HIV in rural Zimbabwe: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e049824
Author(s):  
Andreas D Haas ◽  
Cordelia Kunzekwenyika ◽  
Stefanie Hossmann ◽  
Josphat Manzero ◽  
Janneke van Dijk ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Suicidal Ideation ◽  
Mental Disorders ◽  
Common Mental Disorders ◽  
Cross Sectional Study ◽  
People Living With Hiv ◽  
Art Adherence ◽  
Sectional Study ◽  
Cross Sectional ◽  
Living With Hiv

ObjectivesTo examine the proportion of people living with HIV who screen positive for common mental disorders (CMD) and the associations between CMD and self-reported adherence to antiretroviral therapy (ART).SettingSixteen government-funded health facilities in the rural Bikita district of Zimbabwe.DesignCross-sectional study.ParticipantsHIV-positive non-pregnant adults, aged 18 years or older, who lived in Bikita district and had received ART for at least 6 months.Outcome measuresThe primary outcome was the proportion of participants screening positive for CMD defined as a Shona Symptoms Questionnaire score of 9 or greater. Secondary outcomes were the proportion of participants reporting suicidal ideation, perceptual symptoms and suboptimal ART adherence and adjusted prevalence ratios (aPR) for factors associated with CMD, suicidal ideation, perceptual symptoms and suboptimal ART adherence.ResultsOut of 3480 adults, 18.8% (95% CI 14.8% to 23.7%) screened positive for CMD, 2.7% (95% CI 1.5% to 4.7%) reported suicidal ideations, and 1.5% (95% CI 0.9% to 2.6%) reported perceptual symptoms. Positive CMD screens were more common in women (aPR 1.67, 95% CI 1.19 to 2.35) than in men and were more common in adults aged 40–49 years (aPR 1.47, 95% CI 1.16 to 1.85) or aged 50–59 years (aPR 1.51, 95% CI 1.05 to 2.17) than in those 60 years or older. Positive CMD screen was associated with suboptimal adherence (aPR 1.53; 95% CI 1.37 to 1.70).ConclusionsA substantial proportion of people living with HIV in rural Zimbabwe are affected by CMD. There is a need to integrate mental health services and HIV programmes in rural Zimbabwe.Trial registration numberNCT03704805.

Factors associated with interest in a long-acting HIV regimen: perspectives of people living with HIV and healthcare providers in four European countries

2021 ◽  
pp. sextrans-2020-054648
Author(s):  
Babatunde Akinwunmi ◽  
Daniel Buchenberger ◽  
Jenny Scherzer ◽  
Martina Bode ◽  
Paolo Rizzini ◽  
...  
Keyword(s):  
Unmet Needs ◽  
Resource Constraints ◽  
Hiv Treatment ◽  
Transmission Risk ◽  
People Living With Hiv ◽  
Privacy Concerns ◽  
Medical Needs ◽  
Suboptimal Adherence ◽  
Long Acting ◽  
Living With Hiv

ObjectivesA novel long-acting regimen (LAR) of cabotegravir and rilpivirine for HIV treatment requires dosing every 2 months instead of daily. We assessed what proportion of people living with HIV and physicians would be interested in trying and offering LAR respectively and why.Methods688 people living with HIV on treatment, and 120 HIV physicians completed web-based surveys in Germany, Italy, the UK and France during 2019. Balanced description of a hypothetical LAR regarding efficacy, administration and possible side effects were provided. The hypothetical long-acting injections were assumed to be cost-neutral to current daily oral antiretrovirals. Interest of people living with HIV in trying (‘very’/’highly’) and physicians’ willingness to offer (‘definitely’/’probably’) this LAR in different situations, with perceived benefits/concerns was measured.ResultsOf people living with HIV, 65.8% were interested in trying LAR. The majority (~80%–90%) of those with unmet needs felt LAR would help, including those with strong medical needs (malabsorption and interfering gastrointestinal conditions), suboptimal adherence, confidentiality/privacy concerns and emotional burden of daily dosing. Of physicians, percentage willing to offer LAR varied situationally: strong medical need (dysphagia, 93.3%; malabsorption, 91.6%; interfering gastrointestinal issues, 90.0%; central nervous system disorders, 87.5%); suboptimal adherence (84.2%); confidentiality/privacy concerns (hiding medications, 86.6%) and convenience/lifestyle (84.2%). People living with HIV liked LAR for not having to carry pills when travelling (56.3%); physicians liked the increased patient contact (54.2%). Furthermore, 50.0% of people living with HIV perceived LAR would minimise transmission risk and improve their sexual health. The most disliked attribute was scheduling appointments (37.2%) and resource constraints (57.5%) for people living with HIV and physicians, respectively. Physicians estimated 25.7% of their patients would actually switch.ConclusionProviders and people living with HIV viewed the described LAR as addressing several unmet needs. Alternative treatment routes and especially LAR may improve adherence and quality of life.

scholarly journals Symptoms of common mental disorders and adherence to antiretroviral therapy among adults living with HIV in rural Zimbabwe: a cross-sectional study

2021 ◽  
Author(s):  
Andreas D Haas ◽  
Cordelia Kunzekwenyika ◽  
Stefanie Hossmann ◽  
Josphat Manzero ◽  
Janneke H van Dijk ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Suicidal Ideation ◽  
Mental Disorders ◽  
Common Mental Disorders ◽  
Cross Sectional Study ◽  
People Living With Hiv ◽  
Art Adherence ◽  
Sectional Study ◽  
Cross Sectional ◽  
Living With Hiv

Objectives: To examine the proportion of people living with HIV who screen positive for common mental disorders (CMD) and the associations between CMD and self-reported adherence to antiretroviral therapy (ART). Setting: Sixteen government-funded health facilities in the rural Bikita district of Zimbabwe. Design: Cross-sectional study. Participants: HIV-positive non-pregnant adults, aged 18 years or older, who lived in Bikita district and had received ART for at least six months. Outcome measures: The primary outcome was the proportion of participants screening positive for CMD defined as a Shona Symptoms Questionnaire (SSQ-14) score of 9 or greater. Secondary outcomes were the proportion of participants reporting suicidal ideation, perceptual symptoms, and suboptimal ART adherence and adjusted prevalence ratios (aPR) for factors associated with CMD, suicidal ideation, perceptual symptoms, and suboptimal ART adherence. Results: Out of 3,480 adults, 18.8% (95% confidence interval [CI] 14.8-23.7) screened positive for CMD, 2.7% (95% CI 1.5-4.7) reported suicidal ideations, and 1.5% (95% 0.9-2.6) reported perceptual symptoms. Positive CMD screens were more common in women (adjusted prevalence ratio [aPR] 1.67, 95% CI 1.19-2.35) than in men and were more common in adults aged 40-49 years (aPR 1.47 95% CI 1.16-1.85) or aged 50-59 years (20.3%; aPR 1.51 95% CI 1.05-2.17) than in those 60 years or older. Positive CMD screen was associated with suboptimal adherence (aPR 1.53; 95% CI 1.37-1.70). Conclusions: A substantial proportion of people living with HIV in rural Zimbabwe are affected by CMD. There is a need to integrate mental health services and HIV programs in rural Zimbabwe.

Self-esteem and motivation with adherence of people living with HIV/AIDS (PLWHA) in Indonesia with antiretroviral therapy: a cross-sectional study

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Purwaningsih Purwaningsih ◽  
Candra Panji Asmoro ◽  
Yenis Anggi Prastiwi
Keyword(s):  
Antiretroviral Therapy ◽  
Self Esteem ◽  
Cross Sectional Study ◽  
The Body ◽  
People Living With Hiv ◽  
Art Adherence ◽  
Sectional Study ◽  
Cross Sectional ◽  
Living With Hiv ◽  
Hiv Aids

Abstract Introduction Antiretroviral therapy (ART) helps reduce the amount of human immunodeficiency virus (HIV) that enters the body in order to avoid acquired immune deficiency syndrome (AIDS) and prevents the occurrence of opportunistic infections and complications. This study aims to describe the correlation between self-esteem and motivation with adherence of people living with HIV/AIDS (PLWHA) in ART. Methods This cross-sectional study involved 91 PLWHA who joined a non-government organization (NGO) support group, determined through a purposive sampling technique. The demography, and questionnaires about self-esteem, motivation and adherence to ART were employed to collect the raw data. The data were then analyzed using Spearman’s rho test with the degree of significance at p < 0.05. Results The result showed that self-esteem (p = 0.000, r = 0.445) and motivation (p = 0.019, r = 0.246) had correlation with adherence of PLWHA with ART. Conclusion PLWHA can increase self-esteem and motivation so that they can improve ART adherence. Further research is expected to use an instrument more objectively as a measurement tool for ART adherence in addition to a questionnaire so as to obtain more accurate and specific results.

Undetected anogenital sexually transmitted infections among young adults living with HIV and receiving antiretroviral therapy: Implications for HIV treatment as prevention

2021 ◽  
pp. 095646242110465
Author(s):  
Seth C Kalichman ◽  
Lisa A Eaton ◽  
Moira O Kalichman
Keyword(s):  
Antiretroviral Therapy ◽  
Sexually Transmitted Infections ◽  
Sexual Behaviors ◽  
Hiv Transmission ◽  
Treatment As Prevention ◽  
People Living With Hiv ◽  
Art Adherence ◽  
Sexually Transmitted ◽  
Condomless Anal Intercourse ◽  
Living With Hiv

Undetected sexually transmitted infections (STIs) pose health threats to people living with HIV and when combined with uncontrolled HIV can amplify HIV transmission. The current study screened 174 self-identified men under age 36 living with HIV and receiving antiretroviral therapy (ART) for urethral and rectal incident chlamydia and gonorrhea infections. Participants were also screened for biomarkers indicating alcohol and other drug use, subclinical genital inflammation, and HIV viral load. ART adherence and sexual behaviors were also assessed prospectively over 1 month. Results detected an undiagnosed STI in 32 (18%) individuals. Participants with a previously undetected STI had significantly greater HIV viremia than those who did not have an STI after controlling for several confounding variables. Participants with an undetected STI also engaged in greater condomless anal intercourse with HIV negative and unknown status partners, including partners to whom they had not disclosed their HIV status. These findings show that undetected STI are associated with incomplete ART adherence and unsuppressed HIV, all of which are important for preventing HIV transmission.

scholarly journals The level and potential determinants of the adherence to the antiretroviral therapy among patients on HIV treatment in gemena referral hospital, South Ubangi, Democratic Republic of Congo, 2018

2020 ◽  
Vol 10 (3) ◽  
pp. 79-84
Author(s):  
Charles Kombi K ◽  
Jerome Mastaki K ◽  
Antoinette Tshefu K ◽  
Micheline Fatuma ◽  
Herve Nzereka K
Keyword(s):  
Antiretroviral Therapy ◽  
Family Support ◽  
Optimal Level ◽  
Hiv Treatment ◽  
Referral Hospital ◽  
P Value ◽  
Art Adherence ◽  
Age Group ◽  
The Family ◽  
Suboptimal Adherence

Introduction: Suboptimal adherence to antiretroviral therapy (ART) is a major hinderance to achieving the 90 90 90 goals in limited resources settings. South Ubangi province in DR Congo faces countless challenges providing universal HIV care. However, the level of ART adherence and associated factors among people on HIV treatment in this province remains unknown. Using a quantitative method approach, this study aimed to know the extend of adherence and to identify the determinants of optimal and suboptimal adherence among study participants. Methods: A cross-sectional research design was used to survey patients on ART in Gemena Referral Hospital. Results: After a simple randomly sampling from a sampling frame of 503 patients on treatment and who met the inclusion criteria of been using HIV treatment for at least one year, 438 were selected taking the even numbers in three rounds, but only 398 patients consented to participate to the study. Logistic regression was run to explore determinants of the adherence. The participants’ mean age was 42 years old (range: 8-62 years old). 280 participants were Female (=70.4%) and 118 were male (29.6%) with a sex ratio Female-male of 2.4/1. Most of the participants were married 185(46.5%), 45 were divorced (=1.3%), 136 widow/widowers (34.2% made up of 116 widowers=29% and 20 widows=4.2%) and only 32 were unmarried (8%). Among the married, 117 had only one partner (29% of overall), 42 had more than one partner (11%) and 26 were in a mere cohabitation (6.5%). ART adherence was 77% in the study population, while it should reach the optimal level of 95%. Adherence was positively associated with age, but suboptimal adherence was significantly associated with forget to take the drugs, distance, the degree of contentment to the family support, and moving out of home. Adherence was likely associated with age, in fact, old participants(44-60 age group) had 8.3 times an increased probability of being adherent( 2.30-8.84, 95% CI, p-value=0.001) compared to 8-25 age group. Additionally, taking his pills on daily basis had 1.68 times an increased probability of optimal adherence (1.39-1.98, 95% CI, p-value<0.001), compared to those patients who sometimes forget to take their pills. Distance < or = 5 km also had 2.47 an increased probability of being adherent (2.06-2.87, p-value<0.001) compared to people who live beyond 5 km from the health facility. Participants who stated they had a high degree of contentment to family support presented 1.93 times an increased probability of being adherent (1.93-1.46, 95% CI, p-value=0.001) compared with those with low degree of contentment to the family support. Participants who were resident had 1.55 times an increased significant probability to be adherent (1.28-1.82, 95% CI, p-value<0.001), compared to those who temporarily/definitely moved out their home for any reason. Gender, marital status, and monthly income did not have a significant association with adherence to antiretroviral therapy among people surveyed in the study. Conclusion: Suboptimal adherence is still a serious issue among ARVs users in resource limited settings. Further strategies to boost adherence to the optimal level and beyond would imply to increase personal capacities to adhere to therapy instructions, lessen stigma and discrimination barriers by the proxy and within patients’ families and foster the implication of the family members and the community in therapy, promote drugs provisions at home and differentiated health care management, etc.

scholarly journals Does antiretroviral therapy packaging matter? Perceptions and preferences of antiretroviral therapy packaging for people living with HIV in Northern Tanzania.

2019 ◽  
Author(s):  
Charles Muiruri ◽  
Shelley A. Jazowski ◽  
Seleman K. Semvua ◽  
Francis P. Karia ◽  
Brandon A. Knettel ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Final Analysis ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Viral Load Suppression ◽  
Visual Identification ◽  
Northern Tanzania ◽  
Referral Hospitals ◽  
The Cost ◽  
Living With Hiv

Abstract Background: Despite improvements in treatment (e.g., reduction in pill intake), antiretroviral therapy (ART) is dispensed in socially inefficient and uneconomical packaging. To make pills less conspicuous and decrease the risk of being stigmatized, people living with HIV (PLWH) often engage in self-repackaging – the practice of transferring ART from original packaging to alternative containers. This behavior has been associated with ART nonadherence and failure to achieve viral load suppression. While much of the literature on ART packaging has centered around medication adherence, patients stated preferences for ART packaging and packaging attributes that influence the observed ART nonadherence are understudied. Methods: We conducted a qualitative study to elucidate perceptions of ART packaging among PLWH at two large referral hospitals in Northern Tanzania. Interviews were conducted until thematic saturation was reached. Interviews were audio recorded, transcribed and coded. Results: Of the sixteen participants whose data were used in the final analysis, a majority were between 36 and 55 years of age (Mean 45.5 years SD: 11.14), had primary-level education (n=11, 68.75%), were self-employed (n=9, 56.25%), and were taking ART for more than 6 years (n=11, 68.75%). Participants identified three attributes of ART packaging that increased anticipated HIV stigma and prompted self-repackaging, including visual identification, bulkiness, and the rattling noise produced by ART pill bottles. Conclusions: Given the drastic reduction in the number of pills required for HIV treatment, there is opportunity to not only assess the cost-effectiveness of innovative ART packaging, but also evaluate the acceptability of such packaging among PLWH in order to address stigma and improve ART adherence.

scholarly journals Disparities in Integrase Inhibitor Usage in the Modern HIV Treatment Era: a Population-Based Study in a U.S. City

2021 ◽  
Author(s):  
Matthew A Spinelli ◽  
Nancy A Hessol ◽  
Sandra K Schwarcz ◽  
Susan Scheer ◽  
Monica Gandhi ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
San Francisco ◽  
Integrase Inhibitor ◽  
Population Based ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Population Based Study ◽  
Factors Associated ◽  
Living With Hiv

Abstract Integrase inhibitor-based (INSTI) antiretroviral therapy (ART) regimens are preferred for most people living with HIV (PLWH). We examined factors associated with INSTI use among PLWH in San Francisco who started ART in 2009-2016. PLWH who experienced homelessness were less likely, and older PLWH were more likely, to use an INSTI.

Sign in / Sign up

Export Citation Format

Share Document