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Longitudinal analysis of client appointment adherence under Universal Test and Treat strategy: A stepped-wedge trial.
Boeke, Caroline E; Khan, Shaukat; Walsh, Fiona J; Lejeune, Charlotte; Hettema, Anita; Spiegelman, Donna; Okello, Velephi; Bärnighausen, Till.
Afiliação
  • Boeke CE; Clinton Health Access Initiative, Boston, MA, USA.
  • Khan S; Clinton Health Access Initiative, Mbabane, Eswatini.
  • Walsh FJ; Clinton Health Access Initiative, Boston, MA, USA.
  • Lejeune C; Clinton Health Access Initiative, Mbabane, Eswatini.
  • Hettema A; Clinton Health Access Initiative, Mbabane, Eswatini.
  • Spiegelman D; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  • Okello V; Ministry of Health, Mbabane, Eswatini.
  • Bärnighausen T; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
HIV Med ; 22(9): 854-859, 2021 10.
Article em En | MEDLINE | ID: mdl-34293243
ABSTRACT

OBJECTIVES:

Universal Test and Treat (UTT) strategies are being adopted across sub-Saharan Africa based on clinical benefits to morbidity and mortality and to attain targets of the Joint United Nations Programme on HIV/AIDS (UNAIDS). Universal Test and Treat is expected to change the client population at clinics, due to more asymptomatic HIV clients initiating antiretroviral therapy (ART). We assessed the impact of UTT on client appointment adherence at 14 government-managed health facilities in Eswatini's public sector health system.

METHODS:

We assessed the impact of UTT on client adherence to appointment schedules from 2014 to 2017 in a stepped-wedge trial. Repeated measures analysis was used to assess adherence to each scheduled appointment (primary definition presenting for care within 7 days after the scheduled appointment), adjusting for time, age, sex, stage, marital status, ART status and facility.

RESULTS:

Among 3354 clients (62.1% female; 57.4% < 35 years), a median (interquartile range) of 10 (6-15) appointments were scheduled during follow-up. In a multivariable-adjusted model, appointment adherence was significantly greater in clients who were female [odds ratio (OR) = 1.38, 95% confidence interval (CI) 1.25-1.52], older (e.g. 40 to < 50 years vs. < 20 years; OR = 1.45, 95% CI 1.00-2.09), married (OR = 1.31, 95% CI 1.19-1.44), had lower WHO stage at study enrolment (1-2 vs. 3-4 OR = 1.26, 95% CI 1.13-1.41), and were currently on ART (OR = 3.55, 95% CI 2.62-4.82). However, UTT strategy was not significantly associated with client adherence to scheduled appointments (OR = 1.02, 95% CI 0.72-1.45).

CONCLUSIONS:

Despite transitioning to UTT, there was no change in visit adherence, a reassuring finding given the large volume of clients currently being initiated at earlier stages of HIV.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecções por HIV / Fármacos Anti-HIV Tipo de estudo: Diagnostic_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: HIV Med Assunto da revista: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecções por HIV / Fármacos Anti-HIV Tipo de estudo: Diagnostic_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: HIV Med Assunto da revista: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Estados Unidos