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

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...

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Autores principales: Molemans, Marjan, Vernooij, Eva, Dlamini, Njabuliso, Shabalala, Fortunate S., Khan, Shaukat, van Leth, Frank, Gomez, Gabriela B., Reis, Ria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850272/
https://www.ncbi.nlm.nih.gov/pubmed/30739385
http://dx.doi.org/10.1111/tmi.13214
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author Molemans, Marjan
Vernooij, Eva
Dlamini, Njabuliso
Shabalala, Fortunate S.
Khan, Shaukat
van Leth, Frank
Gomez, Gabriela B.
Reis, Ria
author_facet Molemans, Marjan
Vernooij, Eva
Dlamini, Njabuliso
Shabalala, Fortunate S.
Khan, Shaukat
van Leth, Frank
Gomez, Gabriela B.
Reis, Ria
author_sort Molemans, Marjan
collection PubMed
description 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.
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spelling pubmed-68502722019-11-18 Changes in disclosure, adherence and healthcare interactions after the introduction of immediate ART initiation: an analysis of patient experiences in Swaziland Molemans, Marjan Vernooij, Eva Dlamini, Njabuliso Shabalala, Fortunate S. Khan, Shaukat van Leth, Frank Gomez, Gabriela B. Reis, Ria Trop Med Int Health Original Research Papers 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. John Wiley and Sons Inc. 2019-03-03 2019-05 /pmc/articles/PMC6850272/ /pubmed/30739385 http://dx.doi.org/10.1111/tmi.13214 Text en © 2019 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research Papers
Molemans, Marjan
Vernooij, Eva
Dlamini, Njabuliso
Shabalala, Fortunate S.
Khan, Shaukat
van Leth, Frank
Gomez, Gabriela B.
Reis, Ria
Changes in disclosure, adherence and healthcare interactions after the introduction of immediate ART initiation: an analysis of patient experiences in Swaziland
title Changes in disclosure, adherence and healthcare interactions after the introduction of immediate ART initiation: an analysis of patient experiences in Swaziland
title_full Changes in disclosure, adherence and healthcare interactions after the introduction of immediate ART initiation: an analysis of patient experiences in Swaziland
title_fullStr Changes in disclosure, adherence and healthcare interactions after the introduction of immediate ART initiation: an analysis of patient experiences in Swaziland
title_full_unstemmed Changes in disclosure, adherence and healthcare interactions after the introduction of immediate ART initiation: an analysis of patient experiences in Swaziland
title_short Changes in disclosure, adherence and healthcare interactions after the introduction of immediate ART initiation: an analysis of patient experiences in Swaziland
title_sort changes in disclosure, adherence and healthcare interactions after the introduction of immediate art initiation: an analysis of patient experiences in swaziland
topic Original Research Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850272/
https://www.ncbi.nlm.nih.gov/pubmed/30739385
http://dx.doi.org/10.1111/tmi.13214
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