System-level factors as predictors of adherence to clinical appointment schedules in antiretroviral therapy in Cambodia

Abstract

Adherence to clinical appointment schedules by patients on antiretroviral therapy (ART) is necessary for the prevention of medication interruptions, viral rebound, and the development of drug resistance. An observational study conducted in 2010, Enablers and Adherence to Antiretroviral Therapy in Cambodia, sought to identify factors that predict on-time clinical appointment attendance by patients on ART. Clinical data, including appointment attendance across five consecutive visits, were collected from hospital records on a random sample of ART patients at government referral hospitals (RHs) in Battambang Province, Cambodia. Interviews were conducted to obtain quantitative information from patients on their experiences of support services provided by local NGOs and RHs. This information was used to identify ART patient care and support system factors that could potentially enable patients to adhere to clinical appointment schedules. These factors included adherence counseling, support groups, home-based care (HBC) services, and support provided for transportation to ART appointments. Bivariate and multivariable logistic regression analysis was done to assess relationships between system variables and the ART appointment adherence outcome. Of the 289 study participants, 20.4% had missed at least one of the five appointments in the study period. The hospital source of ART services, participation in a hospital-based support group, receiving a loan from a microfinance institution, and the frequency of adherence counseling were found to be associated with ART appointment adherence. No significant associations were found between other support system factors such as HBC, transportation support, food/monetary support, and appointment adherence.

Interventions to Improve Antiretroviral Therapy Adherence Among Adolescents and Youth in Low- and Middle-Income Countries: A Systematic Review 2015–2019

“…socioeconomic status, stigma) [34,35], health services factors (e.g. clinic waiting times, drug availability, quality of care) [36,37], and medication factors (e.g. dosing, high pill burden, side effects) [3,38,39].…”

Sociodemographic profile and predictors of outpatient clinic attendance among HIV-positive patients initiating antiretroviral therapy in Selangor, Malaysia

“… 14 , 16 , 36 , 41 , 42 Unlike in other parts of the world, race/ethnicity has been rarely associated with outpatient clinic attendance behavior among Asians. 19 , 20 We found a significant association between Indian race and likelihood of missed outpatient clinic appointments among our study cohort. This finding is consistent with a previous report among Malaysians with chronic diseases attending an outpatient family practice clinic in Kuala Lumpur, Malaysia.…”

“…With the exception of one study conducted in Uganda, 13 studies conducted in United States, South America, Africa, and Asia among HIV-positive patients attending outpatient clinics have consistently reported prevalence rates of missed appointment above 20%. 5 , 14 , 17 , 19 , 20 , 36 The lower prevalence (18.7%) reported in this study is probably partly due to the fact that half of the respondents in this study had received SMS and telephone call reminders for their scheduled clinic appointments throughout the study period. In addition, it is important to note that ours was a cohort initiating ART, and therefore has possibly higher than normal attendance rates.…”

“… 18 More often than not, system-level factors such as adherence counseling, hospital-based support group, and high family support have been more consistently associated with regular clinic attendance among HIV-positive patients receiving ART in Asia. 19 , 20 Provider-level factors such as availability, attitude, and communication styles of HIV clinicians and other health care team members have also been reported to influence clinic attendance. 21 …”

Referral Systems to Integrate Health and Economic Strengthening Services for People with HIV: A Qualitative Assessment in Malawi

“…The locally managed referral networks offer bidirectional clinic-to-community referrals to improve the health of individuals and the communities in which they live. The particular goal of clinic-to-community referral networks is to create a sense of shared responsibility and establish a platform for ongoing dialogue between the health system and the community to reduce factors that can be barriers to care, whether they are related to the clients or to the support system 12 . Referral networks can include government, civil society, and community-based service providers, and they provide an important forum for information, education, and communication across these entities, many of which would not otherwise interact.…”