Predictors of Self-repackaging of Antiretroviral Therapy in Northern Tanzania.

Objectives: In this study, we explored determinants of "researcher-observed" patient-initiated antiretroviral therapy (ART) repackaging practices among people living with HIV (PLHIV) in Northern Tanzania. Methods: We used a quasi-experimental design to describe the prevalence of ART self- repackaging; we conducted face-to-face surveys to determine factors associated with ART self- repackaging practices. Data collection sites included the Kilimanjaro Christian Medical Centre and the Mawenzi Referral Hospital. We used study-specific numerical identifiers assigned to ARTs packaging to determine self-repackaging behavior. Self-repackaging was defined as a binary variable where participants who discarded antiretroviral drugs packaging in at least 2 clinic visits were classified as self- repackagers. We used multivariable logistic regression to assess the determinants of patient-initiated repackaging practices. Results: Among 590 study participants, 57.6% self-repackaged based on researcher observation and 55.6% self-repackaged based on patient report. Researcher-observed self- repackaging was associated with gender (AOR = 1.590; 95% CI: 1.011, 2.502), employment status (AOR = 0.475: 95% CI; 0.239, 0.942), and study site (AOR = 0.218; 95% CI: 0.134, 0.355). Conclusions: A substantial proportion of patients self-repackage their ARTs for various reasons. Health system interventions should focus on addressing the attributes of repackaging among men and unemployed patients.

Is lack of health insurance a predictor of worsening of heart failure among adult patients attending referral hospitals in Northwestern Tanzania?

INTRODUCTION: Health insurance coverage is critical for persons living with chronic conditions such as heart failure. Lack of health insurance may affect the ability to access regular healthcare appointments, pay for medication refills which can result in frequent hospitalization that is associated with poor clinical outcomes. In scarce resource locations such as sub-Saharan Africa, where uptake of health insurance is still suboptimal, the effect of health insurance on chronic conditions such as heart failure is poorly understood. The objective of this study was to assess the association of health insurance on the severity of heart failure for patients attending outpatient clinics at tertiary hospitals in Mwanza, Tanzania. METHODS: As part of a larger cohort study, patients with heart failure were recruited from Bugando Medical Center (BMC) and Sekou Toure Regional Hospital (STRH) in Mwanza City, Tanzania. Heart failure was based on Framingham criteria and the severity was determined by New York Heart Association (NYHA) classification. Descriptive analysis and multivariable logistic regression were used to describe the study participants and to assess the association between health insurance status and the severity of heart failure at baseline. RESULTS: 418 patients were enrolled, and majority were female (n = 264, 63%), small scale farmers (n = 278, 66.5%) and were from Mwanza City (n = 299, 71.5%). More than two-thirds of patients did not have health insurance (n = 295, 70.6%) and the majority were in the NYHA I and II classification (n = 267, 64.7%). There was no association between health insurance status and the severity of heart (aOR 0.97; 95% CI 0.84-1.60). Being male, small-scale businessperson and those seen at STRH was associated with higher odds of being in NYHA Class III/IV (aOR = 1.97; 95% CI: 1.21-3.17), (aOR = 2.61; 95% CI: 1.27-5.34) and (aOR 1.91 95% CI: 1.17-3.13) respectively. Having secondary and college education was associated with lower odds of being in Class III/IV (0.42; 95% CI: 0.18-0.98) and (aOR = 0.23 95% CI: 0.06-0.86) respectively. CONCLUSION: In this study, only a third of the patients had health insurance. Health insurance was not associated with the severity of heart failure. Since heart failure is a chronic condition patients who do not have health insurance may incur out of pocket expenses, future research should focus on the effect of out-of-pocket expenditures on clinical outcomes.