학술논문
Adherence to PI-based 2nd-line regimens in Cambodia is not simply a question of individual behaviour: the ANRS 12276 2PICAM study.
Document Type
Academic Journal
Author
Sagaon-Teyssier L; Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France.; Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.; Mmadi Mrenda B; Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France.; Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.; Khol V; National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia.; Ferradini L; WHO, Cambodia Office, Phnom Penh, Cambodia.; Mam S; National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia.; Ngin S; National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia.; Mora M; Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France.; Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.; Maradan G; Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France.; Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.; Vun Mean C; National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia.; University of Health Sciences, Phnom-Penh, Cambodia.; Ségéral O; University of Health Sciences, Phnom-Penh, Cambodia.; French Agency for Research on AIDS and Viral Hepatitis, Paris, France.; Nerrienet E; Institut Pasteur, Paris, France.; Saphonn V; National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia.; University of Health Sciences, Phnom-Penh, Cambodia.; Spire B; Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France.; Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.
Source
Publisher: Blackwell Scientific Publications Country of Publication: England NLM ID: 9610576 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-3156 (Electronic) Linking ISSN: 13602276 NLM ISO Abbreviation: Trop Med Int Health Subsets: MEDLINE
Subject
Language
English
Abstract
Objectives: To investigate whether adherence to antiretroviral treatment (ART) can be explained not only by individual factors but also by health care facilities' characteristics, among a sample of people living with HIV (PLWH) treated with PI-based regimens in Cambodia.
Methods: The ANRS 12276 2PICAM cross-sectional survey was conducted between February 2013 and April 2014 among PLWH followed up in 13 health care facilities. The 1316 patients in this analysis corresponded to 90% of the total number of adult patients treated with 2nd-line PI-based regimens in Cambodia in the study period. A variable indicating whether patients were non-adherent (=1) or completely adherent (=0) was constructed. Health care facilities and individual characteristics were included in a two-level logistic model to investigate their influence on patients' adherence to ART.
Results: A total of 17% of participants did not adhere to ART. Patients in health care facilities outside the capital Phnom Penh were six times more likely to be non-adherent than those treated in health care facilities in the capital (OR: 6.15, 95% CI [1.47, 25.79]). Providing psychosocial care (provided by psychologist counsellors and/or full-time coaches) was found to be a structural facilitator of adherence, as the probability of non-adherence fell by 38.5% per each additional psychological worker present in health care facilities (OR: 0.62, 95% CI [0.43, 0.89]). Financial constraints were the main individual factor preventing adherence.
Conclusions: Our results suggest that inefficiencies in health care delivery are detrimental to PLWH health and to the exceptional progress currently being made by Cambodia in response to HIV. Policy makers should focus on increasing the number of psychosocial workers, especially in areas outside the capital.
(© 2017 John Wiley & Sons Ltd.)
Methods: The ANRS 12276 2PICAM cross-sectional survey was conducted between February 2013 and April 2014 among PLWH followed up in 13 health care facilities. The 1316 patients in this analysis corresponded to 90% of the total number of adult patients treated with 2nd-line PI-based regimens in Cambodia in the study period. A variable indicating whether patients were non-adherent (=1) or completely adherent (=0) was constructed. Health care facilities and individual characteristics were included in a two-level logistic model to investigate their influence on patients' adherence to ART.
Results: A total of 17% of participants did not adhere to ART. Patients in health care facilities outside the capital Phnom Penh were six times more likely to be non-adherent than those treated in health care facilities in the capital (OR: 6.15, 95% CI [1.47, 25.79]). Providing psychosocial care (provided by psychologist counsellors and/or full-time coaches) was found to be a structural facilitator of adherence, as the probability of non-adherence fell by 38.5% per each additional psychological worker present in health care facilities (OR: 0.62, 95% CI [0.43, 0.89]). Financial constraints were the main individual factor preventing adherence.
Conclusions: Our results suggest that inefficiencies in health care delivery are detrimental to PLWH health and to the exceptional progress currently being made by Cambodia in response to HIV. Policy makers should focus on increasing the number of psychosocial workers, especially in areas outside the capital.
(© 2017 John Wiley & Sons Ltd.)