SidaSubSaharaV1, Pmc, Corpus, bibRecord, 000F85

Predictors of Adherence to Antiretroviral Therapy in Rural Zambia

Identifieur interne : 000F85 ( Pmc/Corpus ); précédent : 000F84; suivant : 000F86

Predictors of Adherence to Antiretroviral Therapy in Rural Zambia

Auteurs : James G. Carlucci ; Aniset Kamanga ; Robb Sheneberger ; Bryan E. Shepherd ; Cathy A. Jenkins ; John Spurrier ; Sten H. Vermund

Source :

Journal of acquired immune deficiency syndromes (1999) [ 1525-4135 ] ; 2008.

RBID : PMC:2743102

Abstract

Background/Objective

Antiretroviral therapy (ART) adherence levels of ≥95% optimize outcomes and minimize HIV drug resistance. As such, identifying barriers to adherence is essential. We sought to assess travel to point-of-care for ART as a potential barrier to adherence in rural Zambia, within the context of patient demographics, perceived stigma, and selected clinical indices.

Methods

We studied 424 patients receiving ART from the Macha Mission Hospital (MMH). Interviews ascertained age, gender, education, perceived stigma, nearest rural health facility (RHF), and mode/cost/time of transport for each study participant. Motorcycle odometer and global positioning system way-points measured distance from the MMH to each of the RHFs, estimating patients’ home-to-MMH travel distances. Body mass index, World Health Organization HIV/AIDS stage, and pill counts were assessed from review of patients’ medical and pharmacy records.

Results

At least 95% adherence was documented for 83.7% of the patients in their first months of ART. Travel-related factors did not predict adherence. Adherence was higher for those on ART for a longer time (odds ratio = 1.04 per day; P = 0.002).

Conclusions

Patients in rural Zambia can achieve adherence rates compatible with good clinical outcomes despite long travel distances. The MMH was able to provide quality HIV/AIDS care by implementing programmatic features selecting for a highly adherent population in this resource-limited setting.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2743102

DOI: 10.1097/QAI.0b013e318165dc25
PubMed: 18209678
PubMed Central: 2743102

Links to Exploration step

PMC:2743102

Le document en format XML

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<author><name sortKey="Carlucci, James G" sort="Carlucci, James G" uniqKey="Carlucci J" first="James G." last="Carlucci">James G. Carlucci</name>
<affiliation><nlm:aff id="A1"> Institute of Global Health, Departments of Pediatrics and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Kamanga, Aniset" sort="Kamanga, Aniset" uniqKey="Kamanga A" first="Aniset" last="Kamanga">Aniset Kamanga</name>
<affiliation><nlm:aff id="A2"> Malaria Institute at Macha, Macha, Zambia</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Sheneberger, Robb" sort="Sheneberger, Robb" uniqKey="Sheneberger R" first="Robb" last="Sheneberger">Robb Sheneberger</name>
<affiliation><nlm:aff id="A3"> Institute for Human Virology, University of Maryland, Baltimore, MD</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Shepherd, Bryan E" sort="Shepherd, Bryan E" uniqKey="Shepherd B" first="Bryan E." last="Shepherd">Bryan E. Shepherd</name>
<affiliation><nlm:aff id="A1"> Institute of Global Health, Departments of Pediatrics and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Jenkins, Cathy A" sort="Jenkins, Cathy A" uniqKey="Jenkins C" first="Cathy A." last="Jenkins">Cathy A. Jenkins</name>
<affiliation><nlm:aff id="A1"> Institute of Global Health, Departments of Pediatrics and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Spurrier, John" sort="Spurrier, John" uniqKey="Spurrier J" first="John" last="Spurrier">John Spurrier</name>
<affiliation><nlm:aff id="A4"> Macha Mission Hospital, Macha, Zambia</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Vermund, Sten H" sort="Vermund, Sten H" uniqKey="Vermund S" first="Sten H." last="Vermund">Sten H. Vermund</name>
<affiliation><nlm:aff id="A1"> Institute of Global Health, Departments of Pediatrics and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN</nlm:aff>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Predictors of Adherence to Antiretroviral Therapy in Rural Zambia</title>
<author><name sortKey="Carlucci, James G" sort="Carlucci, James G" uniqKey="Carlucci J" first="James G." last="Carlucci">James G. Carlucci</name>
<affiliation><nlm:aff id="A1"> Institute of Global Health, Departments of Pediatrics and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Kamanga, Aniset" sort="Kamanga, Aniset" uniqKey="Kamanga A" first="Aniset" last="Kamanga">Aniset Kamanga</name>
<affiliation><nlm:aff id="A2"> Malaria Institute at Macha, Macha, Zambia</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Sheneberger, Robb" sort="Sheneberger, Robb" uniqKey="Sheneberger R" first="Robb" last="Sheneberger">Robb Sheneberger</name>
<affiliation><nlm:aff id="A3"> Institute for Human Virology, University of Maryland, Baltimore, MD</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Shepherd, Bryan E" sort="Shepherd, Bryan E" uniqKey="Shepherd B" first="Bryan E." last="Shepherd">Bryan E. Shepherd</name>
<affiliation><nlm:aff id="A1"> Institute of Global Health, Departments of Pediatrics and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Jenkins, Cathy A" sort="Jenkins, Cathy A" uniqKey="Jenkins C" first="Cathy A." last="Jenkins">Cathy A. Jenkins</name>
<affiliation><nlm:aff id="A1"> Institute of Global Health, Departments of Pediatrics and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Spurrier, John" sort="Spurrier, John" uniqKey="Spurrier J" first="John" last="Spurrier">John Spurrier</name>
<affiliation><nlm:aff id="A4"> Macha Mission Hospital, Macha, Zambia</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Vermund, Sten H" sort="Vermund, Sten H" uniqKey="Vermund S" first="Sten H." last="Vermund">Sten H. Vermund</name>
<affiliation><nlm:aff id="A1"> Institute of Global Health, Departments of Pediatrics and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN</nlm:aff>
</affiliation>
</author>
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<series><title level="j">Journal of acquired immune deficiency syndromes (1999)</title>
<idno type="ISSN">1525-4135</idno>
<imprint><date when="2008">2008</date>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background/Objective</title>
<p id="P1">Antiretroviral therapy (ART) adherence levels of ≥95% optimize outcomes and minimize HIV drug resistance. As such, identifying barriers to adherence is essential. We sought to assess travel to point-of-care for ART as a potential barrier to adherence in rural Zambia, within the context of patient demographics, perceived stigma, and selected clinical indices.</p>
</sec>
<sec sec-type="methods" id="S2"><title>Methods</title>
<p id="P2">We studied 424 patients receiving ART from the Macha Mission Hospital (MMH). Interviews ascertained age, gender, education, perceived stigma, nearest rural health facility (RHF), and mode/cost/time of transport for each study participant. Motorcycle odometer and global positioning system way-points measured distance from the MMH to each of the RHFs, estimating patients’ home-to-MMH travel distances. Body mass index, World Health Organization HIV/AIDS stage, and pill counts were assessed from review of patients’ medical and pharmacy records.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">At least 95% adherence was documented for 83.7% of the patients in their first months of ART. Travel-related factors did not predict adherence. Adherence was higher for those on ART for a longer time (odds ratio = 1.04 per day; <italic>P</italic>
 = 0.002).</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">Patients in rural Zambia can achieve adherence rates compatible with good clinical outcomes despite long travel distances. The MMH was able to provide quality HIV/AIDS care by implementing programmatic features selecting for a highly adherent population in this resource-limited setting.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article" xml:lang="EN"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
  <pmc-dir>properties manuscript</pmc-dir>
  <front><journal-meta><journal-id journal-id-type="nlm-journal-id">100892005</journal-id>
<journal-id journal-id-type="pubmed-jr-id">21821</journal-id>
<journal-id journal-id-type="nlm-ta">J Acquir Immune Defic Syndr</journal-id>
<journal-title>Journal of acquired immune deficiency syndromes (1999)</journal-title>
<issn pub-type="ppub">1525-4135</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">18209678</article-id>
<article-id pub-id-type="pmc">2743102</article-id>
<article-id pub-id-type="doi">10.1097/QAI.0b013e318165dc25</article-id>
<article-id pub-id-type="manuscript">NIHMS131294</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Predictors of Adherence to Antiretroviral Therapy in Rural Zambia</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Carlucci</surname>
<given-names>James G.</given-names>
</name>
<degrees>BS</degrees>
<xref rid="A1" ref-type="aff">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kamanga</surname>
<given-names>Aniset</given-names>
</name>
<degrees>BSc</degrees>
<xref rid="A2" ref-type="aff">†</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sheneberger</surname>
<given-names>Robb</given-names>
</name>
<degrees>MD</degrees>
<xref rid="A3" ref-type="aff">‡</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Shepherd</surname>
<given-names>Bryan E.</given-names>
</name>
<degrees>PhD</degrees>
<xref rid="A1" ref-type="aff">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Jenkins</surname>
<given-names>Cathy A.</given-names>
</name>
<degrees>MS</degrees>
<xref rid="A1" ref-type="aff">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Spurrier</surname>
<given-names>John</given-names>
</name>
<degrees>MD</degrees>
<xref rid="A4" ref-type="aff">§</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Vermund</surname>
<given-names>Sten H.</given-names>
</name>
<degrees>MD, PhD</degrees>
<xref rid="A1" ref-type="aff">*</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>*</label>
 Institute of Global Health, Departments of Pediatrics and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN</aff>
<aff id="A2"><label>†</label>
 Malaria Institute at Macha, Macha, Zambia</aff>
<aff id="A3"><label>‡</label>
 Institute for Human Virology, University of Maryland, Baltimore, MD</aff>
<aff id="A4"><label>§</label>
 Macha Mission Hospital, Macha, Zambia</aff>
<author-notes><corresp id="FN1">Correspondence to: James G. Carlucci, BS, Vanderbilt University School of Medicine, Institute for Global Health, 2215 Garland Avenue, Light Hall, Room 319, Nashville, TN 37232-0242 (e-mail: <email>james.g.carlucci@vanderbilt.edu</email>
)</corresp>
<fn id="FN2"><p>Reprints to: Sten H. Vermund, MD, PhD, Vanderbilt University School of Medicine, Institute for Global Health, 2215 Garland Avenue, Light Hall, Room 319, Nashville, TN 37232-0242 (e-mail: <email>sten.vermund@vanderbilt.edu</email>
).</p>
</fn>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>22</day>
<month>7</month>
<year>2009</year>
</pub-date>
<pub-date pub-type="ppub"><day>15</day>
<month>4</month>
<year>2008</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>14</day>
<month>9</month>
<year>2009</year>
</pub-date>
<volume>47</volume>
<issue>5</issue>
<fpage>615</fpage>
<lpage>622</lpage>
<abstract><sec id="S1"><title>Background/Objective</title>
<p id="P1">Antiretroviral therapy (ART) adherence levels of ≥95% optimize outcomes and minimize HIV drug resistance. As such, identifying barriers to adherence is essential. We sought to assess travel to point-of-care for ART as a potential barrier to adherence in rural Zambia, within the context of patient demographics, perceived stigma, and selected clinical indices.</p>
</sec>
<sec sec-type="methods" id="S2"><title>Methods</title>
<p id="P2">We studied 424 patients receiving ART from the Macha Mission Hospital (MMH). Interviews ascertained age, gender, education, perceived stigma, nearest rural health facility (RHF), and mode/cost/time of transport for each study participant. Motorcycle odometer and global positioning system way-points measured distance from the MMH to each of the RHFs, estimating patients’ home-to-MMH travel distances. Body mass index, World Health Organization HIV/AIDS stage, and pill counts were assessed from review of patients’ medical and pharmacy records.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">At least 95% adherence was documented for 83.7% of the patients in their first months of ART. Travel-related factors did not predict adherence. Adherence was higher for those on ART for a longer time (odds ratio = 1.04 per day; <italic>P</italic>
 = 0.002).</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">Patients in rural Zambia can achieve adherence rates compatible with good clinical outcomes despite long travel distances. The MMH was able to provide quality HIV/AIDS care by implementing programmatic features selecting for a highly adherent population in this resource-limited setting.</p>
</sec>
</abstract>
<kwd-group><kwd>access to health care</kwd>
<kwd>antiretroviral therapy</kwd>
<kwd>HIV</kwd>
<kwd>medically underserved area</kwd>
<kwd>patient compliance</kwd>
<kwd>Zambia</kwd>
</kwd-group>
<contract-num rid="AI1">P30 AI054999-01</contract-num>
<contract-sponsor id="AI1">National Institute of Allergy and Infectious Diseases Extramural Activities : NIAID</contract-sponsor>
</article-meta>
</front>
</pmc>
</record>

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Predictors of Adherence to Antiretroviral Therapy in Rural Zambia

Predictors of Adherence to Antiretroviral Therapy in Rural Zambia

Source :

Abstract

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