All ETDs from UAB

Advisory Committee Chair

Pauline E Jolly

Advisory Committee Members

John Ehiri

Eric A M Chamot

Kui Zhang

Edward Khan

Document Type

Dissertation

Date of Award

2014

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

PATIENT AND SYSTEM LEVEL FACTORS AS PREDICTORS OF ADHERENCE TO ANTIRETROVIRAL THERAPY APPOINTMENT SCHEDULES IN CAMBODIA GARY T. DAIGLE EPIDEMIOLOGY / INTERNATIONAL HEALTH ABSTRACT On-time attendance at clinical appointments by patients on antiretroviral therapy (ART) is essential to the prevention of medication interruptions, viral rebound, drug resistance, and long term mortality. An observational study conducted in 2010, Enablers and Adherence to Antiretroviral Therapy in Cambodia, sought to identify factors that predict on-time clinical appointment attendance by patients on ART. These factors were classified as either ART patient level factors (e.g. demographic, clinical) or patient care and support system level factors (e.g. adherence counseling, home based care services). A clinical record review and an interviewer administered questionnaire survey were conducted to collect this data for a random sample of 289 ART patients at government referral hospitals in Battambang Province, Cambodia. Approximately 20% of study participants were found to have missed at least one of five ART appointments. Bivariate and multivariable logistic regression analysis was done to identify patient and support system level factors and combinations of these factors that predict appointment attend-ance. The patient level factors found to be associated with missing ART appointments were: being on ART for four to five years; having a spouse who is aware of the participant's HIV status, and; working as a teacher. The significance of these associations in-creased when they were combined in a multivariable logistic regression model. Having signs/symptoms of illness documented at an ART visit during the study time frame was associated with on-time attendance. The care and support system factors associated with on-time appointment attendance were: the hospital source of ART services; the frequency of medication adherence counseling during ART visits, and; receiving a loan from a microfinance institution. Participation in a hospital based support group was associated with missed appointments. Further analysis of subgroups found an association between receiving adherence counseling during home based care visits and on-time attendance. No significant associations were found between other support system factors (home based care, transportation support, food/monetary support, etc.) and appointment adherence. Study findings reveal areas for additional investigation using qualitative methods and provide information that may be useful in the planning of future research and interventions to improve ART appointment adherence.

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