title: Factors associated with different patterns of nonadherence to HIV care in Dar es Salaam, Tanzania.
abstract: Health system responsiveness (HSR), a measure of patient health care experience, may influence adherence to HIV/AIDS care and be an important predictor of outcomes. We studied the relationship between HSR, patient factors, and visit nonadherence in 16 President's Emergency Plan for AIDS Relief-supported HIV/AIDS clinics in Dar es Salaam. An HSR survey was administered in 2009, and all clinic visits 1 year following the interviews were analyzed for 720 patients on antiretrovirals (ARVs). Definitions of visit nonadherence were (1) low visit constancy ([VC], no visit in ≥1 quarter), (2) gaps in care (>60 days between visits), (3) no visit in last quarter (VLQ). The relationships between factors were analyzed using multivariate analysis with adjusted odds ratio (AOR) and 95% confidence intervals (CI) reported. Few patients were nonadherent using VLQ (14%) and VC (28%). Gaps in care were more common (49.6%) and associated with younger age (AOR: 3.86 [2.02-7.40]), no explanation of side effects (AOR: 2.21 [1.49-3.28]), and shorter antiretroviral therapy (ART) duration (0-3 months AOR: 1.49 [1.09-2.03]; 3-6 months AOR: 2.44 [1.40-4.25]). No VLQ was associated with younger age (AOR: 3.40 [1.63-7.07]), poor health care worker (HCW) communication (AOR: 4.83 [1.39-16.78]), and less time on ART (0-3 months AOR: 5.04 [2.47-10.30]; 3-6 months AOR: 3.09 [1.72-5.57]). Younger age, poor HCW communication, and shorter ART duration also predicted lower VC, as did higher patient-HCW ratios. The rates of visit nonadherence differed based on the definitions used. Younger age, shorter time on ART, and poor HCW communication predicted lower adherence regardless of the definition. More work is needed to understand the relationship between HSR, patient factors, and different patterns of visit nonadherence and their impact on ART outcomes.
authors.affiliation: Maine Medical Center Portland, ME, USA.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Poles
authors.forename: Michelle
authors.initials: M
authors.lastname: Li
authors.forename: Hellen
authors.initials: H
authors.lastname: Siril
authors.forename: Aisa
authors.initials: A
authors.lastname: Mhalu
authors.forename: Claudia
authors.initials: C
authors.lastname: Hawkins
authors.forename: Sylvia
authors.initials: S
authors.lastname: Kaaya
authors.forename: Eric
authors.initials: E
authors.lastname: Aris
authors.forename: Guerino
authors.initials: G
authors.lastname: Chalamilla
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Hirschhorn
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D013636:Tanzania / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents