Evaluating the Evaluating the association of association of
Treatment buddy(TBy) Treatment buddy(TBy) to ART appointment to ART appointment
adherence and adherence and retention in Kisumuretention in Kisumu
PresenterKibaara Charles K.
Kibaara C.1,2, Blat, C.2,3, Lewis-kulzer, J K.2,3 , Mbullo P.1,2, Bukusi EA.1,2, Cohen CR.2,3
January 2013University of Nairobi Annual Collaborative
Meeting
IntroductionIntroduction
Treatment Buddy(Tby)(i.e. a friend or family member, known to the clinic, helping the patient taking ART) is not requested but patients are advised to have one-Sometimes referred at treatment supporter
Background Background
HIV-infected patients on antiretroviral therapy (ART) who miss clinic appointments risk:
• Drug interruptions• Poorer health outcomes• Drug resistance
Kenyan ART Guidelines encourage a Treatment Buddy (Tby) to maximize patient adherence
Study ObjectivesStudy Objectives To examine if having a TBy reduces the
risk of missed appointment or loss to follow-up (LTFU) within first year on ART
• We defined Missed appointment as missing clinic appointment day by more than 3 days after ones “clinic return date”
• LTFU defined as any person whose last TCA was scheduled > 90 days before the date the file is reviewed, and who has not come to the clinic for care, AND is NOT dead, transfer out, declined care *Excluding those who discontinued
Methods Methods
SampleRetrospective cohort studyFour Family AIDS Care and Education Services (FACES) supported health facilities in Kisumu, KenyaHIV-infected adults >15 years of ageInitiated ART between August 1, 2007 and March 27, 2011 Patient demographics, clinic attendance, and Tby status at ART initiation abstracted from electronic medical records
Methods cont’dMethods cont’d Analysis Bivariate logistic regression to
assess whether patients with a TBy had lower odds of missed appointment or LTFU
Breslow-Day test to assess whether effects of Tby on appointment adherence and LTFU differed by gender
Odds ratios (OR) and 95% confidence intervals (CI) reported
Results (Variables)Results (Variables)Comparing patients with Treatment Buddy
•Among a cohort of 2,074 patients, 1,390 (67%) were female and 684 (33%) were male
•Among the patients with Tbys were 1,211(87.1%) females and 645 (94.3%) males
ResultsResults
Comparing patients with Treatment Buddy
Patients with a Tby were older(mean age=33.8 vs. 31.2 years; OR=1.03 per year increase in age, 95% CI=1.02-1.05)
more likely to be married/partnered (58% vs. 38%; OR=2.07, 95% CI=1.49-2.89) compared to those without a TBy.
Results Results Missed appointment within first year on ART (n =
2074)
Total n % missed appt.
OR (95% CI)
Females
TBy 1211 51% 0.59 (0.42-0.81)
No TBy 179 64% 1
Males
TBy 645 56% 0.97 (0.51-1.86)
No TBy 39 56% 1
Breslow-Day test detected a slight trend toward differences by gender
p = 0.17
Results Results LTFU within first year on ART (n = 1902)*
Total n % LTFU OR (95% CI)
Females
TBy 1106 13% 0.78 (0.50-1.22)
No TBy 166 16% 1
Males
TBy 594 16% 1.20 (0.45-3.15)
No TBy 36 14% 1
Breslow-Day test detected no difference in odds of LTFU by gender
p = 0.43
*Excludes discontinued within first year on ART.
Conclusion Conclusion
Tbys may be more strongly associated with appointment adherence in females than males.
TBys were not associated with better first-year retention.
Further research is needed to elucidate the effects of TBy on adherence, retention and clinical outcomes in patients on ART.
AcknowledgementsAcknowledgements PERFAR/CDC MOH FACES UCSF KEMRI
QuestionsQuestions
