Baseline adherence, socio-demographic, clinical, immunological, virological and anthropometric characteristics of 242 HIV positive patients on ART in Malaysia

Adherence to antiretroviral therapy (ART) prevents disease progression, and the emergence of resistant mutations. It also reduces morbidity, and the necessity for more frequent, complicated regimens which are also relatively more expensive. Minimum adherence levels of 95% are required for treatment success. Poor adherence to treatment remains a stumbling block to the success of treatment programs. This generates major concerns about possible resistance of the human immunodeficiency virus (HIV) to the currently available ARVs. This paper aims to describe baseline results from a cohort of 242 Malaysian patients receiving ART within the context of an intervention aimed to improve adherence and treatment outcomes among patients initiating ART. A single-blinded Randomized Controlled Clinical Trial was conducted between January and December, 2014 in Hospital Sungai Buloh. Data on socio-demographic factors, clinical symptoms and adherence behavior of respondents was collected using modified, pre-validated Adult AIDS Clinical Trials Group (AACTG) adherence questionnaires. Baseline CD4 count, viral load, weight, full blood count, blood pressure, Liver function and renal profile tests were also conducted and recorded. Data was analyzed using SPSS version 22 and R software. Patients consisted of 215 (89%) males and 27 (11%) females. 117 (48%) were Malays, 98 (40%) were Chinese, 22 (9%) were Indians while 5 (2%) were of other ethnic minorities. The mean age for the intervention group was 32.1 ± 8.7 years while the mean age for the control group was 34.7 ± 9.5 years. Mean baseline adherence was 80.1 ± 19.6 and 85.1 ± 15.8 for the intervention and control groups respectively. Overall mean baseline CD4 count of patients was 222.97 ± 143.7 cells/mm³ while overall mean viral load was 255237.85 ± 470618.9. Patients had a mean weight of 61.55 ± 11.0 kg and 61.47 ± 12.3 kg in the intervention and control groups, respectively. Males account for about 90% of those initiating ART in the HIV clinic, at a relatively low CD4 count, high viral load and sub-optimal medication adherence levels at baseline

Socio-demographic profile and predictors of outpatient clinic attendance among HIV-positive patients initiating antiretroviral therapy in Selangor, Malaysia

Background: Inconsistent literature evidence suggests that sociodemographic, economic, and system- and patient-related factors are associated with clinic attendance among the HIV-positive population receiving antiretroviral therapy (ART) around the world. We examined the factors that predict outpatient clinic attendance among a cohort of HIV-positive patients initiating ART in Selangor, Malaysia. Patients and Methods: This cross-sectional study analyzed secondary data on outpatient clinic attendance and sociodemographic, economic, psychosocial, and patient-related factors among 242 adult Malaysian patients initiating ART in Selangor, Malaysia. Study cohort was enrolled in a parent randomized controlled trial (RCT) in Hospital Sungai Buloh Malaysia between January and December 2014, during which peer counseling, medication, and clinic appointment reminders were provided to the intervention group through short message service (SMS) and telephone calls for 24 consecutive weeks. Data on outpatient clinic attendance were extracted from the hospital electronic medical records system, while other patient-level data were extracted from pre-validated Adult AIDS Clinical Trial Group (AACTG) adherence questionnaires in which primary data were collected. Outpatient clinic attendance was categorized into binary outcome - regular attendee and defaulter categories - based on the number of missed scheduled outpatient clinic appointments within a 6-month period. Multivariate regression models were fitted to examine predictors of outpatient clinic attendance using SPSS version 22 and R software. Results: A total of 224 (93%) patients who completed 6-month assessment were included in the model. Out of those, 42 (18.7%) defaulted scheduled clinic attendance at least once. Missed appointments were significantly more prevalent among females (n=10, 37.0%), rural residents (n=10, 38.5%), and bisexual respondents (n=8, 47.1%). Multivariate binary logistic regression analysis showed that Indian ethnicity (adjusted odds ratio [AOR] =0.235; 95% CI [0.063-0.869]; P=0.030) and heterosexual orientation (AOR =4.199; 95% CI [1.040-16.957]; P=0.044) were significant predictors of outpatient clinic attendance among HIV-positive patients receiving ART in Malaysia. Conclusion: Ethnicity and sexual orientation of Malaysian patients may play a significant role in their level of adherence to scheduled clinic appointments. These factors should be considered during collaborative adherence strategy planning at ART initiation

Socioeconomic predictors of adherence behavior among HIV-positive patients receiving antiretroviral therapy in Selangor, Malaysia

Medication adherence remains a critical link between the prescribed ART regimen and treatment outcome. Several factors may influence adherence behavior. This cross-sectional study aimed to highlight socioeconomic predictors of adherence behavior among a cohort of 242 adult Malaysian patients receiving antiretroviral therapy in Hospital Sungai Buloh, Malaysia, where they were enrolled in a parent study (single-blinded randomized controlled trial) between January and December 2014. Statistical analysis of secondary data on adherence behavior and sociodemographic characteristics of the patients revealed mean age of 33.4 years and ranged from 18 to 64 years; 88.8% were males. A total of 224 (93%) patients who completed 6 months' adherence assessment were included in the model. Of these, 135 (60.3%) achieved optimal adherence. Multivariate binary logistic regression analysis revealed that patient's income and ethnicity were significant predictors of adherence behavior. This may be valuable for targeted programmatic interventions to further enhance successful treatment outcomes among the target population

Impact of reminder module on adherence and treatment outcomes among HIV-positive patients on antiretroviral theraphy in Hospital Sungai Buloh, Malaysia

Introduction: Adherence to treatment remains the cornerstone of long term viral suppression and successful treatment outcomes among patients receiving antiretroviral therapy (ART). According to WHO, minimum adherence levels of 95% are required for treatment success. Poor adherence to treatment (clinic visits and medication adherence) remains a stumbling block to the success of treatment programs and generates major concerns about possible resistance of the HIV virus to the currently available ARVs. The objective of this study was to evaluate the impact of a mobile phone reminder module on adherence and treatment outcomes among HIV positive patients on ART in Malaysia. Methods: A single-blinded, parallel group randomized controlled trial conducted in Hospital Sungai Buloh, Malaysia in which 242 Malaysian patients were randomized to intervention or control groups was conducted between January and December, 2014. Intervention consisted of a reminder module delivered through SMS and telephone call reminders by trained research assistants for 24 consecutive weeks, in addition to adherence counseling at every clinic visit. Data on adherence behavior of patients was collected using specialized, pre-validated Adult AIDS Clinical Trial Group (AACTG) adherence questionnaires. Data on weight, clinical symptoms, CD4 count and viral load tests were also collected. Data was analyzed using SPSS version 21 and R software. A 5% level of statistical significance was considered for all analysis. Repeated measures ANOVA, Friedman’s ANOVA and Multivariate regression models were used to evaluate efficacy of the intervention as well as to establish the relationship between the independent (predictors) and outcome variables. Results: The response rate after 6 months follow up was 93%. There were no significant differences at baseline in gender, employment status, income distribution and residential location of respondents between the intervention and control group. After 6 months follow up, the mean adherence was significantly higher in the intervention group as compared to the control group. The proportion of respondents ii who had good (>95%) adherence was significantly higher in the intervention group. A significantly lower frequency in missed appointments (p=0.001), lower viral load (p=0.001), higher rise in CD4 count (p=0.017), lower incidence of tuberculosis (p=0.001) and OIs (p=0.001) at 6 months follow up, was observed among patients in the intervention group. We found that both medication adherence and clinic attendance significantly predicts immunological and virological outcomes of antiretroviral therapy. Conclusion: The findings of the current study indicates that mobile phone reminders are effective in improving adherence (clinic attendance and medication adherence) and treatment outcomes (immunological and virological) among HIV positive patients on ART. The ubiquitous nature of mobile phones even among HIV positive patients from low to middle income countries provides an excellent platform for targeted health interventions, irrespective of the nature of the epidemic, whether concentrated or generalized. Since the success of ART programs is largely measured by retention on treatment, the potential effects of this intervention in tracking patient’s clinic attendance and ensuring that they are retained in care remains of immense value in HIV programming

Assessment of oral health status and associated lifestyle factors among Malaysian Fishermen in Teluk Bahang, Penang: An analytical cross-sectional study

Background: Given background sparsity of country-specific literature evidence, and the pervasive unhealthy lifestyle habits such as tobacco, alcohol use, and high sugar consumption among fishermen, the aim of this study was to assess the oral health status and associated lifestyle factors among Malaysian fishermen in Teluk Bahang, Penang. Subjects and Methods: In an analytical cross-sectional design, we used simple random sampling technique to select 242 multiracial Malaysian male fishermen aged between 18 and 75 years from five fishing villages located at Gurney Drive, Tanjong Tokong, Tanjong Bungah, Batu Ferringhi, and Teluk Bahang to participate in this study. During four consecutive weekends in January 2017, we conducted face-to-face interviews with participants using a pre-validated, interviewer-administered WHO oral health questionnaire. We categorized participants as having “good” or “poor” oral health based on a mean cutoff score of 14. Multivariate regression models were fitted to assess the oral health status and associated lifestyle factors among the study population, using SPSS version 22. Results: We achieved a response rate of 97.6%. Overall, the prevalence of poor oral health in this study was 47.5%. “Income” (RM/month), “type of fishing,” “additional occupation,” “age” (years), “frequency of pies, buns consumed,” and “frequency of sweets, soft drinks consumed” were significant predictors of oral health status among the fishermen. Conclusion: Poor oral health is relatively highly prevalent among the fishermen in our study. The oral health status of fishermen in Teluk Bahang was consistent with the national average and significantly associated with their sociodemographic and lifestyle factors. Targeted interventions are required to arrest and reverse this trend

Adherence research in Malaysia

Adherence research in Malaysi

Informační podpora doktorského studia

Import 20/04/2006Prezenční výpůjčkaVŠB - Technická univerzita Ostrava. Fakulta strojní. Katedra (352) automatizační techniky a řízen

Predictors of adherence behaviour among HIV positive patients receiving Antiretroviral Therapy (ART) in Malaysia

Introduction: Success of antiretroviral treatment depends on a host of factors, the most important of which is the patient’s adherence behaviour. The objective of this study was to determine whether the introduction of mobile phone technology (SMS and telephone call reminders) can significantly improve adherence and treatment outcomes among HIV positive patients on ART. This paper highlights ‘context-specific’ predictors of adherence behaviour among a cohort of Malaysian patients receiving ART. Methods: A single-blinded RCT was carried out in Hospital Sungai Buloh between January and December 2014 among HIV positive patients on ART. Data on socio-demographic factors, clinical symptoms, and adherence behaviour, assessed using the modified and pre-validated Adult AIDS Clinic Trials Group adherence questionnaires were collected. CD4 count, viral load, weight, full blood count, blood pressure, liver function and renal profile tests were also conducted and recorded. Multivariate regression models were used to examine the relationship between study variables using SPSS version 21 and R software. Results: The overall mean age of 242 respondents was 33.4 (standard deviation (SD) 9.2, range 18-64) years. Majority (88.8%) were males. Overall, 47.9% of respondents were placed on ZDV/3TC/EFV regimen, 47.1% took TDF/FTC/EFV regimen at baseline (ART initiation) while other HAART regimens accounted for only 5% of the distribution altogether. Univariate logistic regression analysis showed that adherence behaviour was significantly associated with ethnicity, monthly income and employment status. After controlling for the effect of age and treatment group, multivariate multinomial logistic regression analysis showed that patient’s employment status (adjusted Odds Ratio 4.46; 95% CI: 3.22, 6.18) was a significant predictor of adherence behaviour among HIV positive patients receiving ART in Malaysia. Conclusion: The findings provide additional support to the growing body of evidence on the strong relationship between patient’s employment status and their adherence behaviour, particularly in concentrated epidemics and low-to-middle income economies

Data from: Effect of HIV and malaria parasites co-infection on immune-hematological profiles among patients attending anti-retroviral treatment (ART) clinic in Infectious Disease Hospital Kano, Nigeria

Background Human immunodeficiency virus (HIV) and malaria co-infection may present worse health outcomes in the tropics. Information on HIV/malaria co-infection effect on immune-hematological profiles is critical for patient care and there is a paucity of such data in Nigeria. Objective To evaluate immune-hematological profiles among HIV infected patients compared to HIV/malaria co-infected for ART management improvement. Methods This was a cross sectional study conducted at Infectious Disease Hospital, Kano. A total of 761 consenting adults attending ART clinic were randomly selected and recruited between June and December 2015. Participants’ characteristics and clinical details including two previous CD4 counts were collected. Venous blood sample (4ml) was collected in EDTA tube for malaria parasite diagnosis by rapid test and confirmed with microscopy. Hematological profiles were analyzed by Sysmex XP-300 and CD4 count by Cyflow cytometry. Data was analyzed with SPSS 22.0 using Chi-Square test for association between HIV/malaria parasites co-infection with age groups, gender, ART, cotrimoxazole and usage of treated bed nets. Mean hematological profiles by HIV/malaria co-infection and HIV only were compared using independent t-test and mean CD4 count tested by mixed design repeated measures ANOVA. Statistical significant difference at probability of <0.05 was considered for all variables. Results Of the 761 HIV infected, 64% were females, with a mean age of ± (SD) 37.30 (10.4) years. Prevalence of HIV/malaria co-infection was 27.7% with Plasmodium falciparum specie accounting for 99.1%. No statistical significant difference was observed between HIV/malaria co-infection in association to age (p = 0.498) and gender (p = 0.789). A significantly (p = 0.026) higher prevalence (35.2%) of co-infection was observed among non-ART patients compared to (26%) ART patients. Prevalence of co-infection was significantly lower (20.0%) among cotrimoxazole users compared to those not on cotrimoxazole (37%). The same significantly lower co-infection prevalence (22.5%) was observed among treated bed net users compared to those not using treated bed nets (42.9%) (p = 0.001). Out of 16 hematology profiles evaluated, six showed significant difference between the two groups (i) packed cell volume (p = <0.001), (ii) mean cell volume (p = 0.005), (iii) mean cell hemoglobin concentration (p = 0.011), (iv) absolute lymphocyte count (p = 0.022), (v) neutrophil percentage count (p = 0.020) and (vi) platelets distribution width (p = <0.001). Current mean CD4 count cell/μl (349±12) was significantly higher in HIV infected only compared to co-infected (306±17), (p = 0.035). A significantly lower mean CD4 count (234.6 ± 6.9) was observed among respondents on ART compared to non-ART (372.5 ± 13.2), p<0.001, mean difference = -137.9). Conclusion The study revealed a high burden of HIV and malaria co-infection among the studied population. Co-infection was significantly lower among patients who use treated bed nets as well as cotrimoxazole chemotherapy and ART. Six hematological indices differed significantly between the two groups. Malaria and HIV co-infection significantly reduces CD4 count. In general, to achieve better management of all HIV patients in this setting, diagnosing malaria, prompt antiretroviral therapy, monitoring CD4 and some hematology indices on regular basis is critical

Summary table of 2-way repeated measures ANOVA showing main effect of group, time and group x time interaction for adherence, CD4 count, viral load and weight.

<p>Summary table of 2-way repeated measures ANOVA showing main effect of group, time and group x time interaction for adherence, CD4 count, viral load and weight.</p