HIV care and treatment models and their association with medication possession ratio among treatment-experienced adults in three African countries
Date
2021
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Tropical Medicine & International Health
Abstract
Objective: How clinics structure the delivery of antiretroviral therapy (ART) services
may influence patient adherence. We assessed the relationship between models of HIV
care delivery and adherence as measured by medication possession ratio (MPR) among
treatment-experienced adults in Tanzania, Uganda and Zambia.
Methods: Eighteen clinics were grouped into three models of HIV care. Model
1-Traditional and Model 2-Mixed represented task-sharing of clinical services between
physicians and clinical officers, distinguished by whether nurses played a role in clinical
care; in Model 3-Task-Shifted, clinical officers and nurses shared clinical responsibilities
without physicians. We assessed MPR among 3,419 patients and calculated clinic-level
MPR summaries. We then calculated the mean differences of percentages and adjusted
residual ratio (aRR) of the association between models of care and incomplete adher ence, defined as a MPR <90%, adjusting for individual-level characteristics.
Results: In the adjusted analysis, patients in Model 1-Traditional were more likely than
patients in Model 2-Mixed to have MPR <90% (aRR = 1.60, 95% CI 1–2.48). Patients
in Model 1-Traditional were no more likely than patients in Model 3-Task-Shifted to
have a MPR <90% (aRR = 1.58, 95% 0.88–2.85). There was no evidence of differences
in MPR <90% between Model 2-Mixed and Model 3-Task-Shifted (aRR = 0.99, 95% CI
0.59–1.66).
Conclusion: Non-physician-led ART programmes were associated with adherence levels
as good as or better than physician-led ART programmes. Additional research is needed
to optimise models of care to support patients on lifelong treatment.
Description
Research Article
Keywords
antiretroviral therapy, HIV/AIDS, medication adherence, Tanzania, Uganda, Zambia