scholarly journals HIV virological non-suppression and factors associated with non-suppression among adolescents and adults on antiretroviral therapy in northern Ethiopia: a retrospective study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Abraham Aregay Desta ◽  
Tewolde Wubayehu Woldearegay ◽  
Nesredin Futwi ◽  
Gebrecherkos Teame Gebrehiwot ◽  
Goyitom Gebremedhn Gebru ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Antiretroviral Drugs ◽  
Resistance Pattern ◽  
Northern Ethiopia ◽  
Art Adherence ◽  
Adherence Level ◽  
Factors Associated ◽  
Number Of Patients ◽  
Adherence Support ◽  
Adolescents And Adults

Abstract Background Despite the benefits of Antiretroviral Therapy (ART), there is a growing concern of treatment failure. This study aimed to assess viral non suppression rate and factors associated with HIV viral non suppression among adolescents and adults on ART in Northern Ethiopia. Methods A retrospective cross sectional study was done on 19,525 study subjects. All the data in the database of Tigray Health Research Institute was exported to Microsoft excel 2010 and then data verification and filtration were done before exporting to STATA 14.0 for analysis. Generalized Estimating Equation (GEE) logistic regression was used for statistical modeling of viral non suppression. Results A total of 5153 (26.39%; 95%CI (25.77%, 27.02)) patients had no viral suppression despite being on ART. Being male (AOR = 1.27, 95% CI: 1.18, 1.37), 15–19 years of age (AOR = 4.86, 95%CI: 3.86, 6.12), patients from primary hospital (AOR = 1.26, 95%CI: 1.05, 1.52), WHO staging II (AOR = 1.31, 95%CI: 1.10, 1.54), poor ART adherence level (AOR = 2.56, 95%CI: 1.97, 3.33), fair ART adherence level (AOR = 1.61, 95%CI: 1.36, 1.90), baseline CD-4 count of < 200 cells/micro liter (AOR = 1.33, 95%CI: 1.14, 1.54), recent CD-4 count of < 200 cells/micro liter (AOR = 3.78, 95%CI: 3.34, 4.27), regimen types: 1c (AZT-3TC-NVP) (AOR = 1.32, 95%CI: 1.22, 1.44), 2 h (TDF-3TC-ATV/R) (AOR = 1.79, 95%CI: 1.27, 2.52) and declined immunological responses after ART initiation (AOR = 1.45, 95%CI: 1.30, 1.61) were significantly associated with viral non-suppression. Conclusions The virological non suppression was high which makes it less likely to achieve the third 90 UNAIDS target. Being male, patients with WHO staging II and poor ART adherence level were significantly associated with viral non suppression. Therefore, intensive adherence support and counseling should be provided. It is also a high time to determine the antiretroviral drugs resistance pattern given the fact that a large number of patients had virological non suppression.

scholarly journals Delivery of HIV Antiretroviral Therapy Adherence Support Services by HIV Care Providers in the United States, 2013 to 2014

2017 ◽  
Vol 16 (6) ◽  
pp. 624-631 ◽  
Author(s):  
John Weiser ◽  
Linda Beer ◽  
John T. Brooks ◽  
Kathleen Irwin ◽  
Brady T. West ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Nurse Practitioners ◽  
Support Services ◽  
International Association ◽  
The United States ◽  
Hiv Care ◽  
Art Adherence ◽  
Care Providers ◽  
Adherence Support ◽  
Hiv Antiretroviral Therapy

Background: Little is known about clinicians’ adoption of recommendations of the International Association of Providers of AIDS Care and others for supporting adherence to antiretroviral therapy (ART). Methods: We surveyed a probability sample of US HIV care providers to estimate the percentage offering 3 ART adherence support services to most or all patients and assessed the characteristics of providers offering all 3 services (comprehensive support) to most or all patients. Results: Almost all providers (95.5%) discussed ART adherence at every visit, 60.1% offered advice about tools to increase adherence, 53.5% referred nonadherent patients for supportive services, and 42.8% provided comprehensive support. Nurse practitioners were more likely to offer comprehensive support as were providers who practiced at Ryan White HIV/AIDS Program-funded facilities, provided primary care, or started caring for HIV-infected patients within 10 years. Conclusion: Less than half of HIV care providers offered comprehensive ART adherence support. Certain subgroups may benefit from interventions to increase delivery of adherence support.

scholarly journals Patient-Provider Communication and Information, Motivation, and Behavioral Skills in HIV-Positive Adults Initiating Antiretroviral Therapy in Haiti

2020 ◽  
Vol 19 ◽  
pp. 232595822095263
Author(s):  
Megan K. Ramaiya ◽  
Elizabeth Haight ◽  
Jane M. Simoni ◽  
Jean Marcxime Chéry ◽  
Witson Dervis ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Treatment ◽  
Provider Communication ◽  
Art Adherence ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Behavioral Skills ◽  
Adherence Support ◽  
Hiv Positive Adults ◽  
Patient Provider Communication

While Haiti has scaled up use of antiretroviral therapy (ART), current studies suggest sub-optimal adherence threatens long-term viral suppression in this understudied setting. Patient-provider communication (PPC) and information, motivation, and behavioral skills (IMB) have been implicated in ART adherence globally. However, no studies have examined their relevance in Haiti. The present mixed-methods study utilized cross-sectional survey data from 128 ART-initiating patients at 2 large HIV treatment sites in Haiti, as well as observational data from 12 clinic visits, to document associations between adherence-related PPC and IMB. Multivariate regression analyses suggested that PPC is associated with IMB constructs. At the bivariate level, more effective PPC was associated with higher levels of adherence-related information and motivation, but not behavioral skills. Observational findings indicate infrequent and non-collaborative adherence support. Taken together, findings lay the groundwork for additional research in the area of PPC, IMB, and ART adherence in Haiti.

scholarly journals The Comparison of Teen Clubs vs. Standard Care on Treatment Outcomes for Adolescents on Antiretroviral Therapy in Windhoek, Namibia

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Farai K. Munyayi ◽  
Brian E. van Wyk
Keyword(s):  
Antiretroviral Therapy ◽  
Treatment Outcomes ◽  
Standard Care ◽  
Psychosocial Support ◽  
Peer Group ◽  
Cohort Analysis ◽  
Hiv Disclosure ◽  
Virologic Suppression ◽  
Art Adherence ◽  
Adherence Support

Background. Adolescents living with HIV (ALHIV) are challenged to adhere to antiretroviral therapy (ART) and achieve and maintain virologic suppression. Group-based adherence support interventions, such as adherence clubs, have been shown to improve long-term adherence in ART patients. The teen club intervention was introduced in 2010 in Namibia to improve treatment outcomes for ALHIV by providing adherence support in a peer-group environment. Adolescents who have completed the full HIV disclosure process can voluntarily join the teen clubs. The current study compared treatment outcomes of ALHIV receiving ART at a specialized paediatric HIV clinic between 1 July 2015 and 30 June 2017 in Windhoek, Namibia. Methods. A retrospective cohort analysis was conducted on routine patient data extracted from the electronic Patient Monitoring System, individual Patient Care Booklets, and teen club attendance registers. A sample of 385 adolescents were analysed: 78 in teen clubs and 307 in standard care. Virologic suppression was determined at 6, 12, and 18 months from study start date, and compared by model of care, age, sex, disclosure status, and ART regimen. Comparisons between adolescents in teen clubs and those receiving standard care were performed using the chi-square test, and risk ratios were calculated to analyze differences in ART adherence and virologic suppression. Results. The average clinician-measured ART adherence was 89% good, 6% fair, and 5% poor amongst all adolescents, with no difference between teen club members and adolescents in standard care ( p  = 0.277) at 3 months. Virologic suppression over the 2-year observation period was 87% (68% fully suppressed <40 copies/ml and 19% suppressed between 40–999 copies/ml), with no difference between teen club members and those in standard care. However, there were statistically significant differences in virologic suppression levels between the younger (10–14 years) adolescents and older (15–19 years) adolescents at 6 months ( p  = 0.015) and at 12 months ( p  = 0.021) and between adolescents on first-line and second-line ART regimen at 6 months ( p  = 0.012), 12 months ( p  = 0.004), and 18 months ( p  = 0.005). Conclusion. The teen club model delivering psychosocial support only did not improve adherence and virologic suppression levels for adolescents in a specialized paediatric ART clinic, neither were they inferior to standard care. Considering the limitations of this study, teen clubs may still hold potential for improving adherence and virologic suppression levels for older adolescents, and more robust research on adherence interventions for adolescents with higher methodological quality is required.

scholarly journals Determinants of Virologic Failure among Adult HIV Patients on First-Line Antiretroviral Therapy at Waghimra Zone, Northern Ethiopia: A Case-Control Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Abrham Emagnu ◽  
Zenahebezu Abay ◽  
Abera Balcha Bulti ◽  
Yaregal Animut
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Virological Failure ◽  
Drug Toxicity ◽  
Case Control Study ◽  
Virologic Failure ◽  
Case Control ◽  
Northern Ethiopia ◽  
Factors Associated ◽  
Control Study

Introduction. The primary goal of antiretroviral therapy (ART) is to reduce the viral load in HIV-infected patients to promote quality of life, as well as to reduce HIV-related morbidity and mortality. A high rate of virologic failure was reported in Waghimra Zone, Northwest Ethiopia, in viral load assessment conducted among HIV-infected patients on ART in the Amhara region. However, there is limited evidence on the determinants of virological failure in the study area. This study aimed to identify the determinants of virological failure among HIV-infected patients on antiretroviral therapy in Waghimra zone, Northern Ethiopia, 2019. Methods. An institutional-based unmatched case-control study was conducted from May 21 to June 30, 2019. Cases were people living with HIV (PLHIV) on ART who had already experienced virological failure; controls were those without virological failure. Data were extracted from 92 cases and 184 controls through chart review using a pretested and structured checklist. The data were entered using Epi Info version 7 and exported to SPSS version 20 for analysis. A multivariate logistic regression analysis was carried out to identify factors associated with virological failure, and variables with a P value <0.05 were considered statistically significant. Results. This study revealed that poor adherence to ART (adjusted odds ratio (AOR) = 4.24, 95% confidence interval (CI): 2.17, 8.31), taking ART for longer than five years (AOR = 3.11, 95% CI: 1.17, 8.25), having drug toxicity (AOR = 3.34, 95% CI: 1.54, 7.23), age of PLHIV ≥ 35 years (AOR = 2.45, 95% CI: 1.29,4.64), and recent CD4 count <200 cells/mm³ (AOR = 3.06, 95% CI: 1.52, 6.13) were factors associated with virologic failure. Conclusion and Recommendation. This study showed that poor adherence to treatment, longer duration on ART, experiencing drug toxicity, older age, and recent CD4 <200 cell/mm³ are factors that increase the risk of virologic failure.

scholarly journals Management Outcome, Mortality and Factors Associated with Mortality Amongst Hospitalized Patients with Stroke. A Cross Sectional Study.

2020 ◽  
Author(s):  
Solomon Weldegebreal ◽  
Kiday Gidey ◽  
Kidu Gidey ◽  
Yirga Legesse Nirayo ◽  
Desilu Mahari Desta ◽  
...  
Keyword(s):  
Aspiration Pneumonia ◽  
Cross Sectional Study ◽  
P Value ◽  
Northern Ethiopia ◽  
Sectional Study ◽  
Cross Sectional ◽  
Time To Death ◽  
Factors Associated ◽  
Number Of Patients ◽  
Outcome Mortality

Abstract Background Outcomes, mortality due to stroke and factors related with mortality are not profoundly known in the northern Ethiopia. Hence, the main purpose of the study was to assess management outcome, mortality and factors associated with mortality amongst stroke patients.Methods A cross sectional study design was used to conduct the study. Patients medical chart were utilized to collect patient information. Patients medical registries who were diagnosed with stroke and treated in Ayder Comprehensive Specialized Hospital over the years were retrospectively seen. Sample size was estimated using single population formula. Medical charts have been assigned a number and patients were selected using systematic random sampling technique. The findings were analyzed using SPSS version 22. Using logistic regression analysis factors associated with mortality in hospital were identified. A P value less than 0.05 were deemed to be significant in all types of analyses.Results About 216 patients with the diagnosis of stroke were studied. Of the total patients studied, 126(58.3%) were females. From the total stroke patients analyzed, 102(47.2%) were discharged with improvement, 44(20.4%) left against medical advice, and 22(10.2%) patients discharged with no change. Moreover, about 48(22.2%) patients died in the hospital. The median time to death was 3 days ranging from 1 to 48 days and the average mean time to death was 6.2±8.7 days. One hundred thirty-six (62.9%) patients had affirmed to have at least one complication during their hospital stay. The total frequency of complication detected was 234 in number and aspiration pneumonia (n=92, 39.4%) was the frequently identified complication. Sever (3-8) record of Glasgow coma scale (GCS) at admission (Adjusted Odds Ratio=15.33, 95%CI:3.77-62.40, p=0.001) and being unconscious (AOR=2.61, 95%CI:1.06-6.40, p=0.037) during admission were positively associated with mortality.Conclusion Substantially higher number of patients died at the hospital. Majority of the patients admitted to the hospital developed complication, aspiration pneumonia being the most frequently affirmed complication during their stay in the wards. Patients with severe GCS and who were unconscious during admission were more likely to die at the hospital. Sketching out strategies to solve the problem will be conducive for the patients with stroke.

scholarly journals Pharmacist-strengthen Adherence to Antiretroviral Therapy and the Contributing Factors among HIV-infected Paediatric Patients in Nigeria

2017 ◽  
Vol 28 (1) ◽  
pp. 5-12
Author(s):  
Shakirat Tyabo Bello
Keyword(s):  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Healthcare Providers ◽  
Drug Adherence ◽  
Contributing Factors ◽  
Adherence Level ◽  
Factors Associated ◽  
Antiretroviral Medication ◽  
Highly Active ◽  
The Right

Introduction: Children adherence to Highly Active Antiretroviral Therapy (HAART) not only creates a problem for the treated children, but also for their caregivers and healthcare providers. The objective of this study was to determine adherence level and evaluate factors associated with better drug adherence among HIV-infected children in Nigeria.Methods: Adherence to HAART was determined prospectively among HIV-infected children attending HAART Clinic in the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Adherence level was measured using self-reported method and patients medical folders. Logistic regression analysis was used to assess factors associated with better drug adherence among the children.Results: In the eighty children studied, mean age at baseline was 2.16±0.74 years and 60% were males. Baseline adherence level was 74.0% which improved to 98.0% over the course of 8-months follow-up intervention by the pharmacist (p<0.043). Forgetfulness of caregivers to administer antiretroviral medication at the right time to the children was the highest reason for non- adherence. Factors associated with better drug adherence were duration on HAART (OR 1.201; 0.253-1.144, p< 0.003), age (OR 0.540; 0.162-1.006, p < 0.001), type of regimen (OR 0.222; 0.134-1.356, p< 0.046) and heavier weights (OR 1.559; 0.403-1.826, p < 0.023).Conclusions: Following pharmacist’s intervention coupled with other factors, adherence to HAART was strengthened with significant improvement in the children medication-taking behaviour.Bangladesh J Medicine Jan 2017; 28(1) : 5-12

scholarly journals Interactive Mobile Phone HIV Adherence Support for Men who Have Sex with Men in the Philippines: Intervention Development and Pilot Testing in the Philippines Connect for Life Study (Preprint)

2021 ◽  
Author(s):  
Cara O'Connor ◽  
Katerina Leyritana ◽  
Aoife M Doyle ◽  
James J Lewis ◽  
Randeep Gill ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Focus Group ◽  
Mobile Phone ◽  
The Philippines ◽  
Art Adherence ◽  
Pilot Phase ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Adherence Support ◽  
Sex With Men

BACKGROUND The Philippines HIV epidemic is one of the fastest growing globally, and infections among men who have sex with men (MSM) are rising at an alarming rate. The World Health Organization (WHO) recommends use of mobile phone health technologies (mHealth) to engage patients in care and ensure high levels of adherence to antiretroviral therapy (ART). Existing mHealth interventions can be adapted and tailored to the context and population served. OBJECTIVE To create a locally tailored intervention using a mobile phone platform to support treatment adherence for HIV patients on antiretroviral therapy (ART) in the Philippines. METHODS A mixed-methods approach guided by the Behavior Change Wheel (BCW) framework was used to adapt an existing mHealth adherence support platform for the local setting and target population. Literature review, retrospective clinical record review, and focus group discussions with patients were conducted to understand the drivers of ART adherence and tailor the intervention accordingly. The resulting intervention was pilot tested for eight weeks, followed by focus group discussions with patients who received the intervention to assess the acceptability of the design. RESULTS Key issues contributing to nonadherence included side effects, lack of behavioral skills for pill taking, social support, metal health, and substance use. Patients identified mHealth as an acceptable mode of intervention delivery, and wanted the mHealth services to be highly personalizable. The study team, clinicians, and software developers integrated these findings into the intervention, which included a menu of services: pill reminders, health tips, adherence feedback, appointment reminders, and symptom reporting. During the pilot phase, technical issues in the interactive voice response system (IVRS) were identified and addressed. Patients who participated in the pilot phase expressed a preference for short message service (SMS) over IVRS. Patients responded positively to the appointment reminders and health tips, while patient feedback on daily/weekly pill reminders and adherence feedback was mixed. CONCLUSIONS The mobile phone-based SMS and IVRS intervention was acceptable to MSM in Manila, Philippines, and qualitative analysis suggested the intervention helped promote ART adherence and appointment attendance.

scholarly journals Prevalence of Nonsuppressed Viral Load and Associated Factors Among Adults Receiving Antiretroviral Therapy in Eswatini, Lesotho, Malawi, Zambia, and Zimbabwe (2015-2017): Results from Population-Based Nationally-Representative Surveys

2020 ◽  
Author(s):  
Andreas D Haas ◽  
Elizabeth Radin ◽  
Avi J Hakim ◽  
Andreas Jahn ◽  
Neena Philip ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Virologic Failure ◽  
Scale Up ◽  
Female Gender ◽  
Antiretroviral Drugs ◽  
People Living With Hiv ◽  
Second Line ◽  
Viral Load Suppression ◽  
Factors Associated

Introduction: The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a target of ≥90% of people living with HIV (PLHIV) receiving antiretroviral therapy (ART) to have viral load suppression (VLS). We examined factors associated with nonsuppressed viral Load (NVL). Methods: We included PLHIV receiving ART aged 15-59 years from Eswatini, Lesotho, Malawi, Zambia, and Zimbabwe. Blood samples from PLHIV were analyzed for HIV RNA and recent exposure to antiretroviral drugs (ARVs). Outcomes were NVL (viral load ≥1000 copies/mL), virologic failure (VF; ARVs present and viral load ≥1000 copies/mL), interrupted ART (ARVs absent and viral load ≥1000 copies/mL), and receiving second-line ART. We calculated odds ratios and incidence rate ratios for factors associated with NVL, VF, interrupted ART, and switching to second-line ART. Results: The prevalence of NVL was 11.2%: 8.2% experienced VF, and 3.0% interrupted ART. Younger age, male gender, less education, suboptimal adherence, receiving nevirapine, HIV non-disclosure, never having married, and residing in Zimbabwe, Lesotho, or Zambia were associated with higher odds of NVL. Among people with NVL, marriage, female gender, shorter ART duration, higher CD4 count, and alcohol use were associated with higher odds for interrupted ART and lower odds for VF. Many people with VF (44.8%) had CD4 counts <200 cells/μL, but few (0.31% per year) switched to second-line ART. Conclusions: Countries are approaching UNAIDS VLS targets for adults. Treatment support for people initiating ART with asymptomatic HIV infection, scale-up of viral load monitoring, and optimized ART regimens may further reduce NVL prevalence.

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