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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.

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

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  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. Description of the Sample *Values are means ±. SD

  6. 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.

  7. 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.

  8. 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%)

  9. 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.

  10. 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

  11. 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

  12. 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.

  13. 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.

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