Clinic Attendance for Antiretroviral Pills Pick-Up among HIV-Positive People in Nepal: Roles of Perceived Family Support and Associated Factors

Rakesh Ayer, Kimiyo Kikuchi, Mamata Ghimire, Akira Shibanuma, Madhab Raj Pant, Krishna C Poudel, Masamine Jimba, Rakesh Ayer, Kimiyo Kikuchi, Mamata Ghimire, Akira Shibanuma, Madhab Raj Pant, Krishna C Poudel, Masamine Jimba

Abstract

Introduction: HIV-positive people's clinic attendance for medication pick-up is critical for successful HIV treatment. However, limited evidence exists on it especially in low-income settings such as Nepal. Moreover, the role of family support in clinic attendance remains under-explored. Therefore, this study was conducted to examine the association between perceived family support and regular clinic attendance and to assess factors associated with regular clinic attendance for antiretroviral pills pick-up among HIV-positive individuals in Nepal.

Methods: A cross-sectional study was conducted among 423 HIV-positive people in three districts of Nepal. Clinic attendance was assessed retrospectively for the period of 12 months. To assess the factors associated, an interview survey was conducted using a semi-structured questionnaire from July to August, 2015. Multiple logistic regression models were used to assess the factors associated with regular clinic attendance.

Results: Of 423 HIV-positive people, only 32.6% attended the clinics regularly. They were more likely to attend them regularly when they received high family support (AOR = 3.98, 95% CI = 2.29, 6.92), participated in support programs (AOR = 1.68, 95% CI = 1.00, 2.82), and had knowledge on the benefits of antiretroviral therapy (AOR = 2.62, 95% CI = 1.15, 5.99). In contrast, they were less likely to attend them regularly when they commuted more than 60 minutes to the clinics (AOR = 0.53, 95% CI = 0.30, 0.93), when they self-rated their health status as being very good (AOR = 0.13, 95% CI = 0.04, 0.44), good (AOR = 0.14, 95% CI = 0.04, 0.46), and fair (AOR = 0.21, 95% CI = 0.06, 0.70).

Conclusion: HIV-positive individuals are more likely to attend the clinics regularly when they receive high family support, know the benefits of antiretroviral therapy, and participate in support programs. To improve clinic attendance, family support should be incorporated with HIV care programs in resource limited settings. Service providers should also consider educating them about the benefits of antiretroviral therapy.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. UNAIDS."15 by 15" a global target achieved Joint United Nations Programme on HIV/AIDS. Geneva, Switzerland: 2015. Available from: . [Accessed date 21 September 2015]
    1. Cohen MS, Smith MK, Muessig KE, Hallett TB, Powers KA, Kashuba AD. Antiretroviral treatment of HIV-1 prevents transmission of HIV-1: where do we go from here? Lancet. 2013;382(9903):1515–24. 10.1016/S0140-6736(13)61998-4
    1. Havlir D, Beyrer C. The beginning of the end of AIDS? N Engl J Med. 2012;367(8):685–7. 10.1056/NEJMp1207138
    1. WHO.Treat all people living with HIV, offer antiretrovirals as additional prevention choice for people at "substantial" risk. World Health Organization; Geneva, Switzerland: 2015. Available from:. [Accessed date 20 October, 2015]
    1. Murray CJ, Ortblad KF, Guinovart C, Lim SS, Wolock TM, Roberts DA, et al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014.
    1. Nolan S, Wood E. End of the debate about antiretroviral treatment initiation. Lancet Infect Dis. 2014;14(4):258–9. 10.1016/S1473-3099(13)70329-3
    1. AIDSTAR. Adult adherence to treatment and retention in care. 2010. Available from: . [Accessed date 4 April 2015]
    1. Catz SL, McClure JB, Jones GN, Brantley PJ. Predictors of outpatient medical appointment attendance among persons with HIV. AIDS Care. 1999;11(3):361–73.
    1. Osterberg L, Blaschke T. Adherence to medication. N Engl J of Med. 2005;353(5):487–97.
    1. Armstrong WS, Del Rio C. Editorial commentary: Falling through the cracks and dying: missed clinic visits and mortality among HIV-infected patients in care. Clin Infect Dis. 2014;59(10):1480–2. 10.1093/cid/ciu607
    1. Daigle GT, Jolly PE, Chamot EA, Ehiri J, Zhang K, Khan E, et al. System-level factors as predictors of adherence to clinical appointment schedules in antiretroviral therapy in Cambodia. AIDS Care. 2015;27(7):836–43. 10.1080/09540121.2015.1024098
    1. Do TN, Nguyen TM, Do MH, Masaya K, Dang TB, Pham TL, et al. Combining cohort analysis and monitoring of HIV early-warning indicators of drug resistance to assess antiretroviral therapy services in Vietnam. Clin Infect Dis. 2012;54 Suppl 4:S306–12. 10.1093/cid/cir1045
    1. Bassett IV, Regan S, Chetty S, Giddy J, Uhler LM, Holst H, et al. Who starts antiretroviral therapy in Durban, South Africa?… not everyone who should. AIDS. 2010;24 Suppl 1:S37–44. 10.1097/01.aids.0000366081.91192.1c
    1. Dyrehave C, Rasmussen DN, Honge BL, Jespersen S, Correia FG, Medina C, et al. Nonadherence is associated with lack of HIV-related knowledge: a cross-sectional study among HIV-infected individuals in Guinea-Bissau. J Int Assoc Provid AIDS Care. 2015.
    1. O'Brien ME, Clark RA, Besch CL, Myers L, Kissinger P. Patterns and correlates of discontinuation of the initial HAART regimen in an urban outpatient cohort. J Acquir Immune Defic Syndr. 2003;34(4):407–14.
    1. WHO. Retention in HIV programmes: Defining the challenges and identifying solutions. World Health Organization; Geneva, Switzerland: 2011.
    1. Ncama BP, McInerney PA, Bhengu BR, Corless IB, Wantland DJ, Nicholas PK, et al. Social support and medication adherence in HIV disease in KwaZulu-Natal, South Africa. Int J Nurs Stud. 2008;45(12):1757–63. 10.1016/j.ijnurstu.2008.06.006
    1. Zachariah R, Teck R, Buhendwa L, Fitzerland M, Labana S, Chinji C, et al. Community support is associated with better antiretroviral treatment outcomes in a resource-limited rural district in Malawi. Trans R Soc Trop Med Hyg. 2007;101(1):79–84.
    1. Poudel KC, Buchanan DR, Amiya RM, Poudel-Tandukar K. Perceived family support and Antiretroviral adherence in HIV-positive individuals: results from a community-based positive living with HIV study. Int Q Community Health Educ. 2015.
    1. Reda AA, Biadgilign S. Determinants of adherence to antiretroviral therapy among HIV-infected patients in Africa. AIDS Res Treat. 2012;2012:574656 10.1155/2012/574656
    1. UNAIDS. Global AIDS update 2016 Joint United Nations Programme on HIV/AIDS. Geneva, Switzerland: 2016. Available from: . [Accessed date 5 June 2016].
    1. NCASC. Country progress report Nepal. National Center for AIDS and STD Control; Kathmandu, Nepal: 2015. Available from: . [Accessed date 23 September 2015].
    1. NCASC. ART service sites, July, 2015. National Center for AIDS and STD Control; Kathmandu,Nepal: 2015. Available from:. [Accessed date 20 September 2015].
    1. NCASC. Factsheet 6: Antiretroviral therapy and care services in Nepal,as of July 2014. National Center for AIDS and STD Control; Kathmandu, Nepal: 2014. Available from: . [Accessed date 20 October 2015]
    1. Wasti SP, Simkhada P, Randall J, Freeman JV, van Teijlingen E. Factors influencing adherence to antiretroviral treatment in Nepal: a mixed-methods study. PloS One. 2012;7(5):e35547 10.1371/journal.pone.0035547
    1. Wasti SP, Simkhada P, Teijlingen ER. Antiretroviral treatment programmes in Nepal: problems and barriers. Kathmandu Univ Med J(KUMJ). 2009;7(27):306–14.
    1. NCASC. National antiretroviral therapy guidelines. National Center for AIDS and STD Control; Kathmandu, Nepal: 2012.
    1. NCASC. National consolidated guidelines for treating and preventing HIV in Nepal. National Center for AIDS and STD Control; Kathmandu, Nepal: 2014.
    1. Shigdel R, Klouman E, Bhandari A, Ahmed LA. Factors associated with adherence to antiretroviral therapy in HIV-infected patients in Kathmandu District, Nepal. HIVAIDS (Auckl). 2014;6:109–16.
    1. Bhatta L, Klouman E, Deuba K, Shrestha R, Karki DK, Ekstrom AM, et al. Survival on antiretroviral treatment among adult HIV-infected patients in Nepal: a retrospective cohort study in Far-western region, 2006–2011. BMC Infect Dis. 2013;13:604 10.1186/1471-2334-13-604
    1. Sharma S, Khadga P, Dhungana GP, Chitrakar U. Medication adherence to antiretroviral therapy among patients visiting antiretroviral therapy center at Tribhuvan University Teaching Hospital, Kathmandu Nepal. Kathmandu Univ Med J (KUMJ). 2013;11(41):50–3.
    1. Thapa R, Amatya A, Pahari DP, Bam K, Newman MS. Nutritional status and its association with quality of life among people living with HIV attending public anti-retroviral therapy sites of Kathmandu Valley, Nepal. AIDS Res Ther. 2015;12:14 10.1186/s12981-015-0056-9
    1. CBS. National population and housing census 2011 Central Bueau of Statistics. Kathmandu, Nepal: 2012. Available from: . [Accessed date 15 February 2015].
    1. Mugavero MJ, Davila JA, Nevin CR, Giordano TP. From access to engagement: measuring retention in outpatient HIV clinical care. AIDS Patient Care STDS. 2010;24(10):607–13. 10.1089/apc.2010.0086
    1. WHO. Assessment of world health organization HIV drug resistance early warning indicators. World Health Organization; Geneva, Switzerland: 2011. Available from: . [Accessed date 4 October 2015].
    1. Kunutsor S, Walley J, Katabira E, Muchuro S, Balidawa H, Namagala E, et al. Clinic attendance for medication refills and medication adherence amongst an antiretroviral treatment cohort in Uganda: a prospective study. AIDS Res Treat. 2010;2010:872396 10.1155/2010/872396
    1. Kunutsor S, Walley J, Katabira E, Muchuro S, Balidawa H, Namagala E, et al. Improving clinic attendance and adherence to antiretroviral therapy through a treatment supporter intervention in Uganda: a randomized controlled trial. AIDS Beha. 2011;15(8):1795–802.
    1. Cauldbeck MB, O'Connor C, O'Connor MB, Saunders JA, Rao B, Mallesh VG, et al. Adherence to anti-retroviral therapy among HIV patients in Bangalore, India. AIDS Res Ther. 2009;6:7 10.1186/1742-6405-6-7
    1. Taiwo BO, Idoko JA, Welty LJ, Otoh I, Job G, Iyaji PG, et al. Assessing the viorologic and adherence benefits of patient-selected HIV treatment partners in a resource-limited setting. J Acquir Immune Defic Syndr. 2010;54(1):85–92. 10.1097/01.qai.0000371678.25873.1c
    1. MOHP. Nepal demographic and health survey. Ministry of Health and Population; Kathmandu, Nepal: 2011.
    1. Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38(1):21–37.
    1. Tas U, Verhagen AP, Bierma-Zeinstra SM, Odding E, Koes BW. Prognostic factors of disability in older people: a systematic review. Br J Gen Pract. 2007;57(537):319–23.
    1. NCASC. Integrated biological and behavioral surveillance (IBBS) survey among injecting drugs users in Kathmandu valley, Nepal. National Center for AIDS and STD Control; Kathmandu, Nepal: 2011. Available from: . [Accessed date 12 February 2015].
    1. MoHSW. ART treatment litreacy course handbook for community based health workers. Ministry of Health and Social Welfare Kingdom of Swaziland. 2007. Available from: .[Accessed date 12 February 2015].
    1. Kohrt BA. Political violence and mental health in Nepal: war in context, structural violence, and the erasure of history. Atlanta: Emory University; 2009.
    1. Shrestha S, Poudel KC, Poudel-Tandukar K, Kobayashi J, Pandey BD, Yasuoka J, et al. Perceived family support and depression among people living with HIV/AIDS in the Kathmandu Valley, Nepal. J Int Assoc Provid AIDS Care. 2014;13(3):214–22. 10.1177/1545109712456741
    1. Amiya RM, Poudel KC, Poudel-Tandukar K, Pandey BD, Jimba M. Perceived family support, depression, and suicidal ideation among people living with HIV/AIDS: a cross-sectional study in the Kathmandu Valley, Nepal. PloS One. 2014;9(3):e90959 10.1371/journal.pone.0090959
    1. IDRE. Regression with stata chapter 2: regression diagnostics.Institute for Digital Research and Education.University of California Los Angeles. 2015. Available from: . [Accessed date 20 October 2015]
    1. Mugavero MJ, Lin HY, Allison JJ, Giordano TP, Willig JH, Raper JL, et al. Racial disparities in HIV virologic failure: do missed visits matter? J Acquir Immune Defic Syndr. 2009;50(1):100–8. 10.1097/QAI.0b013e31818d5c37
    1. Talam NC, Gatongi P, Rotich J, Kimaiyo S. Factors affecting antiretroviral drug adherence among HIV/AIDS adult patients attending HIV/AIDS clinic at Moi Teaching and Referral Hospital, Eldoret, Kenya. East Afr J Public Health. 2008;5(2):74–8.
    1. Yehia BR, Stewart L, Momplaisir F, Mody A, Holtzman CW, Jacobs LM, et al. Barriers and facilitators to patient retention in HIV care. BMC Infect Dis. 2015;15:246 10.1186/s12879-015-0990-0
    1. Mitiku H, Abdosh T, Teklemariam Z. Factors affecting adherence to antiretroviral treatment in harari national regional state, eastern Ethiopia. ISRN AIDS. 2013;2013:960954 10.1155/2013/960954
    1. WHO. Consolidated guidelines on the use of Antiretroviral drugs for treating and preventing HIV infection Recommendations for a public health approach. Second edition 2016. World Health Organization; Geneva, Switzerland. 2016.
    1. Wasti SP, Teijlingen EV, Simkhada P, Randall J, Baxter S, Kirkpatrick P, et al. Factors influencing adherence to antiretroviral treatment in Asian developing countries: a systematic review. Trop Med Int Health. 2012;17(1):71–81. 10.1111/j.1365-3156.2011.02888.x
    1. Simoni JM, Frick PA, Huang B. A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy. Health Psychol. 2006;25(1):74–81.
    1. Wringe A, Roura M, Urassa M, Busza J, Athanas V, Zaba B. Doubts, denial and divine intervention: understanding delayed attendance and poor retention rates at a HIV treatment programme in rural Tanzania. AIDS Care. 2009;21(5):632–7. 10.1080/09540120802385629
    1. Bateganya MH, Amanyeiwe U, Roxo U, Dong M. Impact of support groups for people living with HIV on clinical outcomes: a systematic review of the literature. J Acquir Immune Defic Syndr. 2015;68 Suppl 3:S368–74. 10.1097/QAI.0000000000000519
    1. Méndez MR, Suárez-Pérez EL, Solís-Báez SS. Measuring health literacy among people living with HIV who attend a community-based ambulatory clinic in Puerto Rico. PR Health Sci J. 2015;34(1):31–7.
    1. Bennett IM, Chen J, Soroui JS, White S. The contribution of health literacy to disparities in self-rated health status and preventive health behaviors in older adults. Ann Fam Med. 2009;7(3):204–11. 10.1370/afm.940
    1. Kalichman SC, Pope H, White D, Cherry C, Amaral CM, Swetzes C, et al. Association between health literacy and HIV treatment adherence: further evidence from objectively measured medication adherence. J Int Assoc Physicians AIDS Care (Chic). 2008;7(6):317–23.
    1. Kalichman SC, Rompa D. Functional health literacy is associated with health status and health-related knowledge in people living with HIV-AIDS. J Acquired Immune Defic Syndr. 2000;25(4):337–44.
    1. Kalichman SC, Benotsch E, Suarez T, Catz S, Miller J, Rompa D. Health literacy and health-related knowledge among persons living with HIV/AIDS. Am J Prev Med. 2000;18(4):325–31.
    1. Robbins GK, Johnson KL, Chang Y, Jackson KE, Sax PE, Meigs JB, et al. Predicting virologic failure in an HIV clinic. Clin Infect Dis. 2010;50(5):779–86. 10.1086/650537

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