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  • 1
    Online Resource
    Online Resource
    Impact of immediate initiation of antiretroviral therapy on HIV patient satisfaction
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  AIDS Vol. 34, No. 2 ( 2020-02-1), p. 267-276
    Details
    In: AIDS, Ovid Technologies (Wolters Kluwer Health), Vol. 34, No. 2 ( 2020-02-1), p. 267-276
    Abstract: Immediate ART (or early access to ART for all, EAAA) is becoming a national policy in many countries in sub-Saharan Africa. It is plausible that the switch from delayed to immediate ART could either increase or decrease patient satisfaction with treatment. A decrease in patient satisfaction would likely have detrimental consequences for long-term retention and adherence, in addition to the value lost because of the worsening patient experience itself. We conducted a pragmatic stepped-wedge cluster-randomized controlled trial (SW-cRCT) to determine the causal impact of immediate treatment for HIV on patient satisfaction. Design: This seven-step SW-cRCT took place in 14 public-sector health facilities in Eswatini's Hhohho region, from September 2014 to August 2017. Methods: During each step of the trial, we randomly selected days for data collection at each study facility. During these days, a random sample of HIV patients were selected for outcome assessment. In total, 2629 patients provided data on their overall patient satisfaction and satisfaction with the following four domains of the patient experience using a five-point Likert scale: wait time, consultation time, involvement in treatment decisions, and respectful treatment. Higher values on the Likert scale indicated lower patient satisfaction. We analyzed the data using a multilevel ordered logistic regression model with individuals at the first level and health facilities at the second (cluster) level. Results: The proportional odds ratio (OR) comparing EAAA to control was 0.91 (95% CI 0.66–1.25) for overall patient satisfaction. For the specific domains of the patient experience, the ORs describing the impact of EAAA on satisfaction were 1.04 (95% CI 0.61–1.78) for wait time, 0.90 (95% CI 0.62–1.31) for involvement in treatment decisions, 0.86 (95% CI 0.61–1.20) for consultation time, and 1.35 (95% CI 0.93–1.96) for respectful treatment. These results were robust across a wide range of sensitivity analyses. Over time – and independent of EAAA – we observed a worsening trend for both overall patient satisfaction and satisfaction in the four domains of the patient experience we measured. Conclusion: Our findings support the policy change from delayed to immediate ART in sub-Saharan Africa. Immediate (versus delayed) ART in public-sector health facilities in Eswatini had no effect on either overall patient satisfaction or satisfaction with four specific domains of the patient experience. At the same time, we observed a strong secular trend of decreasing patient satisfaction in both the intervention and the control arm of the trial. Further implementation research should identify approaches to ensure high patient satisfaction as ART programs grow and mature.
    Type of Medium: Online Resource
    ISSN: 0269-9370 , 1473-5571
    URL: Article
    DOI: 10.1097/QAD.0000000000002392
    RVK:
    XA 16838
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2012212-3
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  • 2
    Online Resource
    Online Resource
    The Impact of Immediate Initiation of Antiretroviral Therapy on Patients' Healthcare Expenditures: A Stepped-Wedge Randomized Trial in Eswatini
    Springer Science and Business Media LLC ; 2021
    In:  AIDS and Behavior Vol. 25, No. 10 ( 2021-10), p. 3194-3205
    Details
    In: AIDS and Behavior, Springer Science and Business Media LLC, Vol. 25, No. 10 ( 2021-10), p. 3194-3205
    Abstract: El inicio inmediato de la terapia antirretroviral (TAR) para todas las personas que viven con VIH tiene importantes beneficios para la salud, pero aún se desconocen las implicaciones en el aspecto económico. Este ensayo controlado aleatorizado por clústers (CRT por sus siglas en inglés) por grupos en distintas etapas pretende determinar el impacto del inicio inmediato de la TAR en los gastos sanitarios de los pacientes en Eswatini. Catorce centros sanitarios fueron asignados aleatoriamente a la transición en uno de los siete periodos de la asistencia estándar (elegibilidad para la TAR en niveles definidos de recuento de CD4) a la intervención de TAR inmediato para todos (EAAA). Se entrevistó a 2.261 pacientes con VIH a lo largo del estudio para conocer sus gastos sanitarios del año anterior. Según los modelos de regresión de efectos mixtos, se observó un descenso del 49% (RR: 0,51; IC del 95%: 0,36, 0,72; p 〈 0,001) en el gasto sanitario total del año anterior en el grupo de la EAAA, y un descenso del 98% (RR 0,02; IC del 95%: 0,00, 0,02; p 〈 0,001) en el gasto en asistencia sanitaria privada y tradicional. A pesar de una mayor frecuencia de visitas deatención de VIH para los pacientes que recién comenzaron laTAR, la aplicación inmediata de laTAR redujo los gastos sanitarios de los pacientes dado que buscaron menos atención de proveedores de asistencia sanitaria alternativos. Este estudio añade un importante argumento económico a la recomendación de la Organización Mundial de la Salud de abolir las restricciones de elegibilidad para la terapia antirretroviral basados en el recuento de CD4.
    Type of Medium: Online Resource
    ISSN: 1090-7165 , 1573-3254
    URL: Article
    DOI: 10.1007/s10461-021-03241-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2014832-X
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  • 3
    Online Resource
    Online Resource
    A stepped-wedge randomised trial on the impact of early ART initiation on HIV-patients’ economic outcomes in Eswatini
    eLife Sciences Publications, Ltd ; 2020
    In:  eLife Vol. 9 ( 2020-08-24)
    Details
    In: eLife, eLife Sciences Publications, Ltd, Vol. 9 ( 2020-08-24)
    Abstract: Human immunodeficiency virus (HIV) is an incurable virus that attacks the immune system and affects around 39 million people worldwide. Once diagnosed, HIV can be treated with antiretroviral therapy (ART) to limit its effects and stop it spreading to other people. HIV rates vary across the world, but the African country of Eswatini has the highest prevalence with more than one in four (27%) people classed as HIV-positive. Until 2015, people living with HIV were typically only treated with ART once their immune system weakened. Recent studies found that starting treatment earlier enhances the positive effects of ART. This caused the World Health Organization (WHO) to change their guidelines and advise people living with HIV to begin ART as soon as they are diagnosed. While antiretroviral drugs are usually provided to patients free of charge, accessing care can be expensive for patients because of high transport costs or lost time from income-generating activities. This means starting treatment earlier and, thus, having more frequent healthcare visits, may result in a greater cost to the patient. The economic impact of this change is unclear, and for patients living in poverty, these added costs can affect their decision on whether to continue treatment. Steinert et al. interviewed 3,019 HIV-patients from 14 health facilities in Eswatini who began treatment with ART either immediately after diagnosis or after their immune system became suppressed. Patients were asked about their time spent being active to generate income, employment status, monthly household expenditures, and household living standards. On average, beginning ART earlier appears to have had no large negative effects on the economic wellbeing of patients. The same results were found for patient groups defined by sex, education, age, and time spent taking ART. These findings suggest that starting ART for HIV as soon as possible offers medical benefits and seems to have no large economic consequences for patients in the short term, even for poorer communities. This adds weight to the WHO advice on HIV treatment and supports the need to continue to deliver effective treatments to countries like Eswatini that have a high rate of HIV infection.
    Type of Medium: Online Resource
    ISSN: 2050-084X
    URL: Article
    DOI: 10.7554/eLife.58487
    Language: English
    Publisher: eLife Sciences Publications, Ltd
    Publication Date: 2020
    detail.hit.zdb_id: 2687154-3
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