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Investigating the impact of a community home-based care on mental health and anti-retroviral therapy adherence in people living with HIV in Nepal: a community intervention study.

ABSTRACT: BACKGROUND:HIV-positive people often experience mental health disorders and engage in substance use when the disease progresses. In resource limited settings, mental health services are not integrated into HIV services. In Nepal, HIV-positive people do receive psychosocial support and other basic health care services from a community home-based care intervention; however, the effects of the intervention on health outcomes is not yet known. Therefore, we examined the impact of the intervention on mental health and antiretroviral therapy (ART) adherence. METHODS:We conducted an intervention study to identify the effects of a community home-based care intervention on mental health disorders, substance use, and non-adherence to ART among HIV-positive people in Nepal from March to August 2015. In total, 344 participated in the intervention and another 338 were in the control group. The intervention was comprised of home-based psychosocial support and peer counseling, adherence support, basic health care, and referral services. We measured the participants' depression, anxiety, stress, substance use, and non-adherence to ART. We applied a generalized estimating equation to examine the effects of intervention on health outcomes. RESULTS:The intervention had positive effects in reducing depressive symptoms [Adjusted Odds Ratio (AOR)?=?0.44, p?

SUBMITTER: Pokhrel KN

PROVIDER: S-EPMC5992643 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Investigating the impact of a community home-based care on mental health and anti-retroviral therapy adherence in people living with HIV in Nepal: a community intervention study.

Pokhrel Khem N KN Sharma Vidya D VD Pokhrel Kalpana G KG Neupane Sanjeev R SR Mlunde Linda B LB Poudel Krishna C KC Jimba Masamine M

BMC infectious diseases 20180607 1

<h4>Background</h4>HIV-positive people often experience mental health disorders and engage in substance use when the disease progresses. In resource limited settings, mental health services are not integrated into HIV services. In Nepal, HIV-positive people do receive psychosocial support and other basic health care services from a community home-based care intervention; however, the effects of the intervention on health outcomes is not yet known. Therefore, we examined the impact of the interve ...[more]

PMID: 29879916

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Project description:IntroductionPatient's knowledge and attitude towards their treatment avert stereotypical misconceptions about the disease and its treatment, as well as aid in attaining optimal adherence. This study investigated the knowledge, attitude, practice, and adherence of antiretroviral therapy (ART) clients in Nepal.MethodA cross-sectional study was conducted among 165 ART clients visiting five ART sites in the far western region and the capital city of Nepal. The convenience sampling method was employed, and the data were collected through interviews with ART clients using a validated questionnaire. Binary logistic regression was used to identify associated factors.ResultApproximately 80.7% had adequate knowledge and 55% had a positive attitude towards ART. Stigmatization was associated with ARV by only 4.2%. Half of the participants (50.3%) revealed that they had surreptitiously stored their ART medication, diverging from the recommended storage guidelines. A significant proportion of respondents (33.3%) chose to repackage the medication as a strategy to prevent unintended disclosure of their HIV status. Many (59.3%) believed that ART does not prolong life. Nevertheless, they advocated the regular use of ART rather than taking it only when the health deteriorates (81.8%). The majority (97.6%) were found to be adherent to their ART. There was a significant association of age with a level of knowledge and attitude (p < 0.05). A significant association was also found between knowledge and attitude towards ART (p < 0.05). None of the variables had a significant association with adherence (p > 0.05).ConclusionOverall, adequate knowledge was demonstrated, whereas efforts are still needed to improve the attitude of ART clients towards ART. A need for counseling regarding the storage practices of ART is needed. A focus on ensuring the perfect translation of adequate knowledge and a positive attitude to the practice of ART clients is essential. Whether adequate ART knowledge and attitude scores will lead to near-perfect ART adherence needs further investigation.

Project description:BackgroundAdherence to ART is the primary determinant of viral suppression and the risk of transmission, disease progression and death. Adherence of at least 95% is needed for optimal suppression. This study aimed at determining the adherence to Anti-Retroviral Therapy (ART) and its associated factors among People Living with HIV and AIDS in ART Center of Chitwan, Nepal.MethodsA descriptive cross-sectional study was conducted among 231 clients aged 18 years to 49 years taking ART from Bharatpur Hospital of Chitwan and those who have been enrolled in ART for at least 6 months, were interviewed. Systematic Sampling technique was used. Semi-structured questionnaire was prepared by taking reference from the AIDS Clinical Trial group questionnaire (ACTG). Adherence was measured by patient self report. Data was entered Epi Data 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) software where the P value of < 0.05 was accepted as being statistically significant. The independent variables which were found significant at p-value 0.10 in bivariate analysis were fitted in multivariable logistic regression model. Multivariable logistic regression model was performed to know the net effect of the independent variables on Adherence to ART medication.ResultsThe overall adherence in the last month was found to be 87.4%. Wrist watch and mobiles were seen as a facilitating factor for taking ART on time as clients taking ART used to set alarm to get informed of the medication time. Adherence was associated with female sex (AOR = 10.550 CI: 1.854-60.046), family consisting only parents and their children (AOR = 4.877, CI: 1.246-19.079), having no habit of taking alcohol (AOR = 5.842 CI: 1.294-26.383), HIV duration of more than 3 years (AOR = 10.055 CI: 2.383-42.430), picking up ART medications on their own (AOR = 7.861, CI: 1.670-36.998) and not having side effects of ART (AOR = 8.832, CI: 2.059-37.890).ConclusionIdentifying and evaluating the problems faced by ARV drug users can foster the achievement of ART related goals and addressing ART related problems in a rational way. Effective and appropriate monitoring of non adherence behaviors can help patients increase adherence level fostering improvement in treatment outcome.

Project description:BackgroundAlthough safe and effective anti-retrovirals (ARVs) are readily available, non-adherence to ARVs is highly prevalent among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (PLWHA). Different adherence-improving interventions have been developed and examined through decision analytic model-based health technology assessments. This systematic review aimed to review and appraise the decision analytical economic models developed to assess ARV adherence-improvement interventions.MethodsThe review protocol was registered on PROSPERO (CRD42022270039), and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Relevant studies were identified through searches in six generic and specialized bibliographic databases, i.e. PubMed, Embase, NHS Economic Evaluation Database, PsycINFO, Health Economic Evaluations Database, tufts CEA registry and EconLit, from their inception to 23 October 2022. The cost-effectiveness of adherence interventions is represented by the incremental cost-effectiveness ratio (ICER). The quality of studies was assessed using the quality of the health economics studies (QHES) instrument. Data were narratively synthesized in the form of tables and texts. Due to the heterogeneity of the data, a permutation matrix was used for quantitative data synthesis rather than a meta-analysis.ResultsFifteen studies, mostly conducted in North America (8/15 studies), were included in the review. The time horizon ranged from a year to a lifetime. Ten out of 15 studies used a micro-simulation, 4/15 studies employed Markov and 1/15 employed a dynamic model. The most commonly used interventions reported include technology based (5/15), nurse involved (2/15), directly observed therapy (2/15), case manager involved (1/15) and others that involved multi-component interventions (5/15). In 1/15 studies, interventions gained higher quality-adjusted life years (QALYs) with cost savings. The interventions in 14/15 studies were more effective but at a higher cost, and the overall ICER was well below the acceptable threshold mentioned in each study, indicating the interventions could potentially be implemented after careful interpretation. The studies were graded as high quality (13/15) or fair quality (2/15), with some methodological inconsistencies reported.ConclusionCounselling and smartphone-based interventions are cost-effective, and they have the potential to reduce the chronic adherence problem significantly. The quality of decision models can be improved by addressing inconsistencies in model selection, data inputs incorporated into models and uncertainty assessment methods.

Project description:IntroductionFrailty is a state of being vulnerable to adverse health outcomes such as falls, delirium, and disability in older people. Identifying frailty is important in a low-income setting to prevent it from progressing, reducing healthcare costs, increasing the chances of reversibility, and implementing effective interventions. The factors affecting frailty in older people living in old age homes could differ from those living in the community. This study was conducted to identify the factors associated with frailty in older people residing in old age homes and communities in Kathmandu Valley, Nepal.MethodsThis is a cross-sectional study conducted from April to June 2019 in three districts of Kathmandu Valley, Nepal. Data were collected from 193 older people residing in old age homes and 501 residing in communities aged 60 and above using convenience sampling. Frailty was measured using the Groningen Frailty Indicator. Data were collected via face-to-face interviews. Multiple linear regression analyses were used to examine the association between independent variables and frailty.ResultsFrailty was more prevalent among older people in old age homes (71.5%) compared to those in the community (56.3%). Older people who were satisfied with their living environment had lower frailty scores in both old age homes (β = -0.20, p<0.01) and the community (β = -0.15, p<0.001). Those who had self-rated unhealthy lifestyle had higher frailty scores in both old age homes (β = 0.45, p<0.001) and the community (β = 0.25, p<0.001). In the community, those over 80 years of age had higher frailty scores (β = 0.15, p<0.01) and those with higher education had lower scores (β = -0.13, p<0.05).ConclusionThe living environment and lifestyle are key modifiable risk factors of frailty, both in old age homes and the community. The findings suggest a need for lifestyle modification and reforms in building standards, especially in old age homes, to promote age-friendly communities.

Dataset Information

Investigating the impact of a community home-based care on mental health and anti-retroviral therapy adherence in people living with HIV in Nepal: a community intervention study.

Publications

Investigating the impact of a community home-based care on mental health and anti-retroviral therapy adherence in people living with HIV in Nepal: a community intervention study.

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