The population effectiveness of highly active antiretroviral therapy: Are good drugs good enough?

Giordano, Thomas P.; Suarez‐Almazor, María E.; Grimes, Richard M.

doi:10.1007/s11904-005-0013-7

Cited by 35 publications

(32 citation statements)

References 53 publications

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“…23 Retention in care was defined as having completed at least one visit for HIV primary care in each of 3 or 4 quarter years in the year after diagnosis. 24 Based on treatment recommendations at the time, 25 ART initiation within 1 year of diagnosis was assessed for patients with a baseline CD4+ T cell count less than 350 cells/mm 3 and was dichotomized. Adherence to ART was assessed by average responses on a visual analogue scale of adherence, using all available follow up reports for the participant.…”

Section: Trust Variables and Outcomesmentioning

confidence: 99%

“…1,2 To maximally benefit from ART, patients with HIV must be diagnosed as early as possible, linked to HIV care, retained in care, prescribed ART, and adhere to ART and have an undetectable HIV load. [3][4][5] Unfortunately, among the patients aware of their HIV status, fewer than three-quarters are linked to care in a timely manner and further less than two-thirds are retained in HIV care. 6 As a result, the U.S. Centers for Disease Control and Prevention estimates that of the 1.2 million people in the United States live with human immunodeficiency virus (HIV) infection, only 30% currently have viral suppression.…”

Section: Introductionmentioning

confidence: 99%

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The Influence of Trust in Physicians and Trust in the Healthcare System on Linkage, Retention, and Adherence to HIV Care

Graham

Shahani

Grimes

et al. 2015

AIDS Patient Care and STDs

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Lack of trust by the patient in the physicians or the healthcare system has been associated with poorer health outcomes. The present study was designed to determine if trust in physicians and the healthcare system among persons newly diagnosed with HIV infection was predictive of patients' subsequent linkage, retention, and adherence to HIV care. 178 newly diagnosed HIV infected patients were administered the trust-in-physicians and trust-in-healthcare system scales. Median trust-in-physicians and trust-in-healthcare system scores were compared for all the mentioned subsequent linkage, retention, and adherence to HIV care. Univariate logistic regression using the trust-in-physician scale confirmed significant association with retention in care ( p = 0.04), which persisted in multivariate analyses ( p = 0.04). No significant association was found between trust-inphysicians and linkage to care or adherence to antiretroviral therapy. Trust in the healthcare system was not associated with any of the outcomes. Patients with higher trust in physicians were more likely to be retained in HIV care. Trust at diagnosis may not be a barrier to better clinical outcomes, either because trust changes based on subsequent interactions, or because trust is not a determining feature. Interventions to improve retention in care could include improving trust in physicians or target persons with low trust in physicians.

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Section: Trust Variables and Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Influence of Trust in Physicians and Trust in the Healthcare System on Linkage, Retention, and Adherence to HIV Care

Graham

Shahani

Grimes

et al. 2015

AIDS Patient Care and STDs

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“…35,36,38 Adherence to HIV care is a more comprehensive concept than adherence to HAART, and encompasses medication adherence as one of its elements. 4,5 The validation analyses conducted in this study suggest that within the context of adherence to HIV care, intention is a clinically important variable. Furthermore, the factor analysis found that intention was a single factor rather than a three or four component construct.…”

Section: Discussionmentioning

confidence: 82%

“…2,3 Adherence to HIV care is a concept that includes attendance at appointments and adherence to HAART regimens. 4,5 These two components have been shown to have independent associations with long-term healthcare outcomes. More than 10% of patients taking HAART report missing one or more doses of medications per day, and > 33% report missing doses over a 2-to 4-week period.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Measure for Intention to Adhere to HIV Treatment

Nelsen

Trautner²,

Petersen³

et al. 2012

AIDS Patient Care and STDs

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We present the development and validation of a theory-derived scale measuring patients' behavioral intention to adhere to HIV care. Adherence to HIV care includes attendance at appointments and adherence to highly active antiretroviral therapy (HAART) regimens. These two components have been independently associated with long-term HIV outcomes. Items were chosen to reflect behavioral intention as defined by the Health Action Process Approach to health-seeking behavior. Items reflecting self-reported HIV knowledge were also included after expert panel review. The study took place from October 2009 to April 2010 at two HIV clinics in Houston, Texas. Participants were 287 adults with HIV/AIDS (10.1% female, mean age 50.8); 56.5% were AfricanAmerican and 17% were Hispanic. Of the total, 87.1% were on HAART at enrollment. Factor analysis of survey items resulted in the retention of two domains, knowledge and intention, based on scree plot analysis of eigenvalues. Questions with factor loadings > 0.4 were retained, yielding 4 knowledge questions and 10 intention questions. The survey had good internal consistency for knowledge (Cronbach's a = 0.83) and for intention (Cronbach's a = 0.81). In multivariate analysis, intention was associated with HIV viral suppression, defined as HIV-1 viral load < 400 RNA copies/mL, (odds ratio [OR] = 1.75, 95% .confidence interval [CI] = 1.00-3.07). Knowledge was also associated with HIV suppression (OR = 1.55, 95%, CI = 1.09-2.12). The resulting study describes the development and preliminary validation of an HIV treatment-seeking intention measure. Additional studies are needed to validate this instrument in other populations.

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“…Blood collected at interview was tested for CD4 for 69 respondents and for VL for 61 respondents; first CD4 and/ or VL was available from subsequent monitoring of reports to surveillance for an additional 27 respondents (CD4) and an additional 16 respondents (VL). Of 96 respondents for whom CD4 count was available either through the Never in Care Pilot or a later report to surveillance, 47% had counts of 350 cells/cubic millimeter (mm 3 ) and 20% had counts of 200 cells/ mm 3 ; 44% of the 77 people with VL results had a VL of .100,000 copies/milliliter (mL). Table 3 describes respondents' health and relationship with the health-care system.…”

Section: Resultsmentioning

confidence: 99%

Missed Connections: HIV-Infected People Never in Care

et al. 2013

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Objective. Clinical interventions that lengthen life after HIV infection and significantly reduce transmission could have greater impact if more HIV-diagnosed people received HIV care. We tested a surveillance-based approach to investigating reasons for delayed entry to care. Methods. Health department staff in three states and two cities contacted eligible adults diagnosed with HIV four to 24 months previously who had no reported CD4+ lymphocyte (CD4) or viral load (VL) tests. The staff conducted interviews, performed CD4 and VL testing, and provided referrals to HIV medical care. Reported CD4 and VL tests were prospectively monitored to determine if respondents had entered care after the interview. Results. Surveillance-based follow-up uncovered problems with reporting CD4 and VL tests, resulting in surveillance improvements. However, reporting problems led to misspent effort locating people who were already in care Follow-up proved difficult because contact information in surveillance case records was often outdated or incorrect. Of those reached, 37% were in care and 29% refused participation. Information from 132 people interviewed generated ideas for service improvements, such as emphasizing the benefits of early initiation of HIV care, providing coverage eligibility information soon after diagnosis, and leveraging other medical appointments to provide assistance with linkage to HIV care. Conclusions. Surveillance-based follow-up of HIV-diagnosed individuals not linked to care provided information to improve both surveillance and linkage services, but was inefficient because of difficulties identifying, locating, and recruiting eligible people. Inefficiencies attributable to missing, incomplete, or inaccurate surveillance records are likely to diminish as data quality is improved through ongoing use.

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The population effectiveness of highly active antiretroviral therapy: Are good drugs good enough?

Cited by 35 publications

References 53 publications

The Influence of Trust in Physicians and Trust in the Healthcare System on Linkage, Retention, and Adherence to HIV Care

The Influence of Trust in Physicians and Trust in the Healthcare System on Linkage, Retention, and Adherence to HIV Care

Development and Validation of a Measure for Intention to Adhere to HIV Treatment

Missed Connections: HIV-Infected People Never in Care

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