Can Self-Management Improve HIV Treatment Engagement, Adherence, and Retention? A Mixed Methods Evaluation in Tanzania and Uganda

Autor: Anisa Ismail, Amy F Stern, Jude Ssensamba, Monica M Ngonyani, Tamara Nsubuga-Nyombi, Corrina Moucheraud, Jane Mvungi
Rok vydání: 2019
Předmět:
Male
Pediatric AIDS
Psychological intervention
HIV Infections
Tanzania
0302 clinical medicine
7.1 Individual care needs
Health care
Uganda
030212 general & internal medicine
Pediatric
Engagement
Self-management
biology
Attendance
Health Services
Middle Aged
Infectious Diseases
Retention
Public Health and Health Services
HIV/AIDS
Zero Hunger
Female
Public Health
0305 other medical science
ART
Adult
Social Work
medicine.medical_specialty
Adolescent
Social Psychology
Article
Medication Adherence
Young Adult
03 medical and health sciences
Clinical Research
Behavioral and Social Science
medicine
Humans
Aged
030505 public health
business.industry
Self-Management
Public health
Public Health
Environmental and Occupational Health
Odds ratio
biology.organism_classification
Confidence interval
Adherence
Family medicine
Management of diseases and conditions
business
Zdroj: AIDS Behav
AIDS and behavior, vol 24, iss 5
ISSN: 1573-3254
1090-7165
Popis: This paper presents the evaluation results of a self-management support (SMS) initiative in Tanzania and Uganda, which used quality improvement to provide self-management counseling, nutritional support, and strengthened linkages to community-based services for highest-risk patients (those with malnutrition, missed appointments, poor adherence, high viral load, or low CD4 count). The evaluation assessed improvements in patient engagement, ART adherence, and retention. Difference-in-difference models used clinical data (n=541 in Tanzania, 571 in Uganda) to compare SMS enrollees to people who would have met SMS eligibility criteria had they been at intervention sites. Interviews with health care providers explored experiences with the SMS program and were analyzed using codes derived deductively from the data. By end-line, SMS participants in Tanzania had significantly improved visit attendance (odds ratio 3.53, 95% confidence interval 2.15, 5.77); a non- significant improvement was seen in Uganda (odds ratio 1.62, 95% confidence interval 0.37, 7.02), which may reflect a dose-response relationship due to shorter program exposure there. Self-management can improve vulnerable patients’ outcomes -- but maximum gains may require long implementation periods and accompanying system-level interventions. SMS interventions require long-term investment and should be contextualized in the systems and environments in which they operate.
Databáze: OpenAIRE
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