Changes in disclosure, adherence and healthcare interactions after the introduction of immediate ART initiation: an analysis of patient experiences in Swaziland.

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Tytuł:: Changes in disclosure, adherence and healthcare interactions after the introduction of immediate ART initiation: an analysis of patient experiences in Swaziland.
Autorzy:: Molemans M; Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
Vernooij E; Amsterdam Institute for Social Science Research, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands.; Social Anthropology, School of Social and Political Science, The University of Edinburgh, Edinburgh, UK.
Dlamini N; Amsterdam Institute for Social Science Research, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands.
Shabalala FS; Amsterdam Institute for Social Science Research, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands.; Department of Community Health Nursing Sciences, Faculty of Health Sciences, University of Swaziland, Mbabane, Swaziland.
Khan S; Clinton Health Access Initiative, Mbabane, Swaziland.
van Leth F; Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
Gomez GB; Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
Reis R; Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.; Amsterdam Institute for Social Science Research, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands.; Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.; The Children's Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
Źródło:: Tropical medicine & international health : TM & IH [Trop Med Int Health] 2019 May; Vol. 24 (5), pp. 563-570. Date of Electronic Publication: 2019 Mar 03.
Typ publikacji:: Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Publication: Oxford : Blackwell Scientific Publications
Original Publication: Oxford, UK : Blackwell Science Ltd, c1996-
MeSH Terms:: CD4 Lymphocyte Count*
Disclosure*
Family*
Medication Adherence*
Sexual Partners*
Anti-HIV Agents/*therapeutic use
HIV Infections/*drug therapy
Adult ; Eswatini ; Female ; Health Personnel ; Health Services Accessibility ; Health Status ; Humans ; Male ; Middle Aged ; Professional-Patient Relations ; Viral Load
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Contributed Indexing:: Keywords: ART; VIH; HIV; Swaziland; adherence; adhésion; antiretroviral therapy; disclosure; divulgation; traitement préventif; treatment as prevention
Local Abstract: [Publisher, French] Il y a des craintes que l'initiation de l’ART immédiat (quel que soit la numération des CD4) affecte négativement la divulgation du statut VIH, l'adhésion au traitement et les interactions avec les soins de santé. Nous avons évalué les modifications de ces facteurs après l'intervention «Accès précoce à l’ART pour tous», une étude universelle de dépistage et traitement au Swaziland. MÉTHODES: Nous avons recruté deux échantillons de participants entre 2014 et 2017. Le premier groupe a été interviewé avant l'intervention (témoins), le deuxième groupe lors de l'implémentation et six mois après (intervention). RÉSULTATS: Des niveaux élevés de divulgation aux partenaires (témoin et intervention: 94%) et aux membres de la famille (témoins: 78%, intervention: 79%) ont été rapportés, ainsi que des taux élevés d'adhésion (85% n'ont pas oublié une dose chez les témoins, 84% dans le groupe d'intervention). Aucun changement n'a été observé chez les patients déclarant se sentir poussés à commencer l’ART (témoins: 10%, intervention: 11%). La qualité de l'interaction avec les agents de la santé s'est améliorée après l'intervention; les agents de santé expliquent plus souvent le choix de l'initiation de l’ART (témoins: 88%, intervention: 93%) et la signification des résultats des tests de CD4 et de la charge virale (témoins: 15%, intervention: 47%). Plus de patients du groupe d'intervention ont déclaré avoir reçu les résultats des tests (témoins: 13%, intervention: 46%). Nous n'avons observé aucun changement dans la divulgation, l'adhésion ou l'expérience des patients six mois après le début de l'intervention par rapport à son début. [Publisher, French] Nos résultats suggèrent que les taux d'adhésion et de divulgation rapportés restent élevés après l'introduction de l’ART immédiat au Swaziland. Nous avons observé une amélioration des interactions avec les soins de santé, probablement due à la formation dispensée dans les établissements participants, ce qui constituera un élément important pour le succès du déploiement de l’ART immédiat.
Substance Nomenclature:: 0 (Anti-HIV Agents)
Entry Date(s):: Date Created: 20190211 Date Completed: 20200116 Latest Revision: 20200116
Update Code:: 20240105
PubMed Central ID:: PMC6850272
DOI:: 10.1111/tmi.13214
PMID:: 30739385
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Introduction: There are concerns that immediate ART initiation (regardless of CD4 count) negatively affects HIV status disclosure, ART adherence and healthcare interactions. We assessed changes in these factors after the 'Early access to ART for all' intervention, a universal test-and-treat study in Swaziland.
Methods: We recruited two samples of participants between 2014 and 2017. The first group was interviewed before the intervention (control); the second group at the implementation and 6 months thereafter (intervention).
Results: High levels of disclosure to partners (controls and intervention: 94%) and family members (controls: 78%, intervention: 79%) were reported, and high levels of adherence (85% did not miss a dose among the controls, 84% in the intervention group). There were no changes in patients reporting feeling pressured to initiate ART (controls: 10%, intervention: 11%). The quality of interaction with healthcare workers improved after the intervention; healthcare workers explained more often the choice of ART initiation (controls: 88%, intervention: 93%) and the meaning of both CD4 and viral load test results (controls: 15%, intervention: 47%). More patients in the intervention group reported receiving test results (controls: 13%, intervention: 46%). We observed no changes in disclosure, adherence or patient experiences 6 months into the intervention compared to its start.
Conclusion: Our results suggest that both reported adherence and disclosure levels remain high after the introduction of immediate ART in Swaziland. We observed an improvement in the healthcare interactions, possibly due to training at participating facilities, which will be an important element for a successful roll-out of immediate ART.
(© 2019 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.)

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