title: Determinants of engagement in HIV treatment and care among Zambians new to antiretroviral therapy.
abstract: This pilot study assessed the determinants of engagement in HIV care among Zambian patients new to antiretroviral (ARV) therapy, and the effect of an intervention to increase medication adherence. Participants (n = 160) were randomized to a 3-month group or individual intervention utilizing a crossover design. Psychophysiological (depression, cognitive functioning, health status), social (social support, disclosure, stigma), structural factors (health care access, patient-provider communication), and treatment engagement (adherence to clinic visits and medication) were assessed. Participants initially receiving the group intervention improved their adherence, but gains were not maintained following crossover to the individual intervention. Increased social support and patient-provider communication and decreased concern about HIV medications predicted increased clinic attendance across both arms. Results suggest that early participation in a group intervention may promote increased adherence among patients new to ARV therapy, but long-term engagement in care may be sustained by both one-on-one and group interventions by health care staff.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Jones
authors.forename: Isaac
authors.initials: I
authors.lastname: Zulu
authors.forename: Szonja
authors.initials: S
authors.lastname: Vamos
authors.forename: Ryan
authors.initials: R
authors.lastname: Cook
authors.forename: Ndashi
authors.initials: N
authors.lastname: Chitalu
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D018791:CD4 Lymphocyte Count; D018592:Cross-Over Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010349:Patient Compliance; D010817:Physician-Patient Relations; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D057545:Social Stigma; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult; D015024:Zambia
chemical_list: D019380:Anti-HIV Agents