Antiretroviral Therapy Adherence and Clinic Attendance Over Time Among People in Argentina Living with HIV and Lost to Care.
Background: Although Argentina provides access to no cost HIV care, treatment adherence and retention in care remain suboptimal. This study aimed to explore factors associated with self-reported adherence and appointment attendance over time.
Methods: Participants (N = 360) were people living with HIV (PLWH) that were lost to care (i.e., three missed pharmacy pickups in the last 6 months, or had not attended a physician visit in the last 12 months). Participants were recruited from seven HIV clinics in four urban centers in Argentina and re-engaged in care. Demographic variables, predictors, i.e., alcohol use, self-efficacy, motivation, patient-provider communication, insurance type (private/public), and outcomes, i.e., missed infectious disease (ID) specialist appointments, other missed clinic and lab appointments, and self-reported adherence were assessed over 2 years. A logistic regression and Poisson regression model within a generalized linear mixed model framework was used to analyze the association between predictors, treatment adherence outcomes, and interactions with time.
Results: Following re-engagement in care, increased alcohol use was associated with lower odds of antiretroviral therapy adherence over time, increased odds of missing ID specialist appointments, and missed clinic/lab appointments. Self-efficacy was associated with better medication adherence and fewer missed ID specialist appointments over time. Similarly, both motivation and patient/provider communication were associated with fewer missed ID specialist and clinic/lab appointments over time. Having private health insurance was also associated with less missed clinic/lab appointments.
Conclusions: Findings suggest alcohol use reduction interventions could improve treatment outcomes in this population. Additionally, interventions targeting patient-provider communication and patient self-efficacy and motivation may enhance retention following re-engagement in care.