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Care seeking behaviors and factors for adherence among HIV+ patients in four Mexican hospitals. Lisa DeMaria, Sergio Bautista-Arredondo, Veronika Wirtz Session: WEAB03 - Adherence and Medicines (ARVs) Management XVII International Conference on HIV/AIDS 6 August 2008.

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care seeking behaviors and factors for adherence among hiv patients in four mexican hospitals

Care seeking behaviors and factors for adherence among HIV+ patients in four Mexican hospitals

Lisa DeMaria, Sergio Bautista-Arredondo, Veronika Wirtz

Session: WEAB03 - Adherence and Medicines (ARVs) Management

XVII International Conference on HIV/AIDS

6 August 2008

scaling up art care in mexico in a multi system context
Scaling up ART care in Mexico in a multi-system context
  • 8 years since the Mexican government’s commitment to Universal Access to antiretrovirals.
  • Providing ARV coverage is carried out in a multi-system context:
    • Public health system: Secretaría de Salud (SSA); National Institutes of Health (INSalud)
    • Social security system: IMSS, ISSSTE, Pemex
    • Private sector health care: private practice physicians, hospitals, insurance.
  • Little known about PLWHA history of diagnosis and care, adherence, and patterns in seeking care in a context of multiple systems-- which are crucial to ensure quality of care and adherence.
objectives
Objectives
  • Investigate self-reported care seeking behaviors and adherence within the context of Universal Access.
  • Identify how patients access care and patterns of care seeking, including use of private sector and out-of-pocket expenditures.
  • Analyze factors that affect adherence, in the context of receiving care at public sector institutions.
methodology and sample
Methodology and Sample
  • Exploratory study
  • Patient interviews (2005)
    • 189 HIV+ patients
    • Convenience sample
  • 4 Hospitals in and around Mexico City
    • 2 tertiary care hospitals
    • 1 social security hospital
    • 1 public health hospital (SSA)
  • Pre-coded questionnaire covering socio-economic status, health and HIV history, health expenditures, care received, disease history, quality of life and adherence.
slide5

Description of the Sample

*Values are means ±. SD

experience with haart
Experience with HAART
  • Nearly all currently receiving HAART (98%)
  • They are new to ARV therapy:
    • 65% <1 year on therapy
    • 25% 1-5 years
    • 10% >5 years
  • Feel that treatment is working (94%)
    • 64% feel better
    • 51% are symptom free
    • 29% have gained weight
    • 31% don’t tire as easily
  • They know what they are taking (94%)
  • 24% report that treatment is complicated.
care seeking among institutions
Care seeking among institutions
  • INSalud patients access care from more institutions
  • Seek care at the institutions because they are referred there or because of the perceived quality of care.
  • A minority supplement with private sector care (<17%)
  • All seek ARVs at primary institution.
1 to 2 institutions

Patterns of care seeking

1 to 2 Institutions

> 3 Institutions

Intra-

institucional

(50%)

Intra-

institutional

43%

> 1

INSalud

(81%)

> 1

INSalud

(18%)

Firstinstitution

> 1

INSalud

(61%)

Inter-

institucional

(19%)

Inter-

Institutional

(57%)

Private

Sector

(75%)

Private sector

(12%)

slide9

Median out-of-pocket expenditures (previous 2 months)

82% report out of pocket expenditures for care in previous 6 months

All values expressed in Mexican pesos. SD in brackets.

adherence
Adherence
  • Half reported skipping at least one day of treatment at one time (49%)
  • Seeking care at a greater number of institutions (>3) appears to be associated with non-adherence
  • Most common reason for missing a dose is being out of the house or forgetting (54%)
    • 25% Sick / Side effects
    • 11.25% Couldn’t get meds/stockouts
    • 11.25% Own decision
slide11

Multivariate analysis for Adherence

0 No Adherence, 1 Adherence

Number of observations = 130; Prob> chi^2 = 0.0063

Reference groups: time ARV 0 – 6 mo, no education or elementary school, 1 institution, time receiving attention 0-6 mo

conclusions
Conclusions
  • Inter-institutional referrals are frequent -- 45% referred – and should be handled carefully.
  • Private institutions play a minor role as care providers for PLWHA.
  • Adherence needs to be reinforced in the first year and among patients seeking care from multiple institutions
  • Out-of-pocket expenditures indicate insufficient coverage of additional services required for care of PLWHA.
slide13

http://www.insp.mx

ldemaria@insp.mx

sbautista@insp.mx

vwirtz@insp.mx

We would like to thank UCMexus for funding this study

and Yared Santa Ana for her assistance with the data analysis.