Abdulrahman Surajudeen Abiola, Rampal Lekhraj, Othman Norlijah, Ibrahim Faisal, Hayati Kadir Shahar, Radhakrishnan Anuradha P
Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor.
Department of Public Health Medicine, Penang Medical College, George Town, Penang.
Patient Prefer Adherence. 2017 Jul 27;11:1273-1284. doi: 10.2147/PPA.S141609. eCollection 2017.
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.
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.
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]; =0.030) and heterosexual orientation (AOR =4.199; 95% CI [1.040-16.957]; =0.044) were significant predictors of outpatient clinic attendance among HIV-positive patients receiving ART in Malaysia.
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.
文献证据并不一致，表明社会人口统计学、经济、系统及患者相关因素与全球接受抗逆转录病毒疗法（ART）的HIV阳性人群的门诊就诊情况有关。我们研究了马来西亚雪兰莪州开始接受ART治疗的一组HIV阳性患者中预测门诊就诊的因素。
这项横断面研究分析了242名在马来西亚雪兰莪州开始接受ART治疗的成年马来西亚患者的门诊就诊及社会人口统计学、经济、心理社会和患者相关因素的二手数据。研究队列纳入了2014年1月至12月在马来西亚双溪毛糯医院进行的一项母体随机对照试验（RCT），在此期间，通过短信服务（SMS）和电话为干预组连续24周提供同伴咨询、药物治疗和门诊预约提醒。门诊就诊数据从医院电子病历系统中提取，而其他患者层面的数据从预先验证的成人艾滋病临床试验组（AACTG）依从性问卷中提取，其中收集了原始数据。根据6个月内错过预定门诊预约的次数，将门诊就诊情况分为二元结果——定期就诊者和违约者类别。使用SPSS 22版和R软件拟合多变量回归模型，以检验门诊就诊的预测因素。
共有224名（93%）完成6个月评估的患者纳入模型。其中，42名（18.7%）至少有一次未按预定时间就诊。女性（n = 10，37.0%）、农村居民（n = 10，38.5%）和双性恋受访者（n = 8，47.1%）错过预约的情况明显更普遍。多变量二元逻辑回归分析表明，印度族裔（调整后的优势比[AOR]=0.235；95%可信区间[0.063 - 0.869]；P = 0.030）和异性恋取向（AOR = 4.199；95%可信区间[1.040 - 16.957]；P = 0.044）是马来西亚接受ART治疗的HIV阳性患者门诊就诊的重要预测因素。
马来西亚患者的种族和性取向可能在其遵守预定门诊预约的程度中发挥重要作用。在ART治疗开始时进行协作依从性策略规划时应考虑这些因素。
