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Non-adherence to antiretroviral treatment and unplanned treatment interruption among people living with HIV/AIDS in Cameroon: Individual and healthcare supply-related factors

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  • Boyer, Sylvie
  • Clerc, Isabelle
  • Bonono, Cécile-Renée
  • Marcellin, Fabienne
  • Bilé, Paule-Christiane
  • Ventelou, Bruno

Abstract

In low-income countries, health system deficiencies may undermine treatment continuity and adherence to antiretroviral therapy (ART) that are crucial for the success of large-scale public ART programs. In addition to examining the effects of individual characteristics, on non-adherence to ART and treatment interruption behaviors - i.e. treatment interruption for more than 2 consecutive days during the previous 4 weeks, this study aims to extend our knowledge on the role played by healthcare supply-related characteristics in shaping these two treatment outcomes. These effects are examined using multilevel logistic models applied to a sub-sample of 2381 ART-treated patients followed-up in 27 treatment centers in Cameroon (ANRS-EVAL survey, 2006-2007). Multivariate models show that factors common to both non-adherence and treatment interruption include binge drinking (at the individual-level) and large hospital size (at the healthcare supply-level). Among the individual factors, financial difficulties of paying for HIV-care are the major correlates of treatment interruption [Adjusted Odds Ratio (AOR) 95% confidence interval (CI)Â =Â 11.73(7.24-19.00)]. By contrast, individual factors associated with an increased risk of non-adherence include: having a main partner but not living in a couple compared to patients living in a couple [AOR(95%CI)Â =Â 1.51(1.14-2.01)]; experience of discrimination in the family environment [AOR(95%CI)Â =Â 1.74(1.14-2.65)]; a lack of regular meals [AOR(95%CI)Â =Â 1.93(1.44-2.57)], and switching antiretroviral drugs (ARV) regimen [AOR(95%CI)Â =Â 1.36(1.08-1.70)]. At healthcare facility-level, the main correlate of ART interruption was antiretroviral stock-outs [AOR(95%CI)Â =Â 1.76(1.01-3.32)] whereas the lack of psychosocial support from specialized staff and lack of task-shifting to nurses in medical follow-up were both associated with a higher-risk of non-adherence [respective AOR (95%CI)Â =Â 2.81(1.13-6.95) and 1.51(1.00-3.40)]. Results reveal different patterns of factors for non-adherence and treatment interruption behaviors. They also suggest that psychosocial support interventions targeted at the individual patient-level will not be sufficient to achieve favorable treatment outcomes if not combined with interventions focused on strengthening health systems, including appropriate drug supplies and human resources policies, as well as sustainable and equitable financing mechanisms.

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  • Boyer, Sylvie & Clerc, Isabelle & Bonono, Cécile-Renée & Marcellin, Fabienne & Bilé, Paule-Christiane & Ventelou, Bruno, 2011. "Non-adherence to antiretroviral treatment and unplanned treatment interruption among people living with HIV/AIDS in Cameroon: Individual and healthcare supply-related factors," Social Science & Medicine, Elsevier, vol. 72(8), pages 1383-1392, April.
    • Handle: RePEc:eee:socmed:v:72:y:2011:i:8:p:1383-1392
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    References listed on IDEAS

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    1. Mamadou Camara & Cristina d’Almeida & Fabienne Orsi & Benjamin Coriat, 2008. "Procurement Policies, Governance Models and ARV Availability in French-speaking African Countries: An Overview," Chapters, in: Benjamin Coriat (ed.), The Political Economy of HIV/AIDS in Developing Countries, chapter 11, Edward Elgar Publishing.
    2. Wouters, Edwin & Van Damme, Wim & Van Loon, Francis & van Rensburg, Dingie & Meulemans, Herman, 2009. "Public-sector ART in the Free State Province, South Africa: Community support as an important determinant of outcome," Social Science & Medicine, Elsevier, vol. 69(8), pages 1177-1185, October.
    3. Van Damme, Wim & Kober, Katharina & Kegels, Guy, 2008. "Scaling-up antiretroviral treatment in Southern African countries with human resource shortage: How will health systems adapt?," Social Science & Medicine, Elsevier, vol. 66(10), pages 2108-2121, May.
    4. Nigel Rice & Andrew Jones, 1997. "Multilevel models and health economics," Health Economics, John Wiley & Sons, Ltd., vol. 6(6), pages 561-575, November.
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    1. Kathryn P Derose & Denise D Payán & María Altagracia Fulcar & Sergio Terrero & Ramón Acevedo & Hugo Farías & Kartika Palar, 2017. "Factors contributing to food insecurity among women living with HIV in the Dominican Republic: A qualitative study," PLOS ONE, Public Library of Science, vol. 12(7), pages 1-19, July.
    2. Hyacinthe Tchewonpi Kankeu & Sylvie Boyer & Raoul Fodjo Toukam & Mohammad Abu-Zaineh, 2016. "How do supply-side factors influence informal payments for healthcare? The case of HIV patients in Cameroon," International Journal of Health Planning and Management, Wiley Blackwell, vol. 31(1), pages 41-57, January.
    3. Yunhee Park, 2018. "Psychological Burden and Medication Adherence of Human Immunodeficiency Virus Positive Patients," Global Journal of Health Science, Canadian Center of Science and Education, vol. 10(11), pages 124-124, November.
    4. Tinne Gils & Claire Bossard & Kristien Verdonck & Philip Owiti & Ilse Casteels & Maria Mashako & Gilles Van Cutsem & Tom Ellman, 2018. "Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-12, January.

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