Ragea Goshu, Alemseged Fessahaye, Nigatu Mamo, Dereje Diriba
Department of HIV/AIDS Prevention and Control, CDC Oromia, Jimma, Ethiopia.
Department of Epidemiology, Jimma University, Jimma, Ethiopia.
HIV AIDS (Auckl). 2021 Feb 4;13:145-156. doi: 10.2147/HIV.S282928. eCollection 2021.
Ethiopia is currently implementing an Appointment Spacing Model (ASM) for ART. A study conducted in 6 hospitals that piloted ASM showed that 51% of eligible clients declined ASM. Studies conducted on ASM have focused on its benefits, not factors determining its utilization. This study aimed to identify determinants of ASM non-utilization.
To identify determinants of ASM non-utilization among stable ART clients.
An unmatched case-control study was conducted among 194 cases and 194 controls: consecutively selected stable clients on anti-retroviral therapy (ART) at four public health facilities in Jimma town. Data were collected through face-to-face interviews and observation techniques using semi-structured questionnaire and observation checklist. EpiData version 3.1 and SPSS version 23 were respectively used for data entry and analysis. Descriptive statistics, logistic regression, adjusted odds ratio and 95% CI were used to summarize descriptive data, identify determinants of ASM non-utilization, measure the strength of statistical association, and declare the statistical significance respectively.
With 100% response rate, predictors of ASM non-utilization were residing in urban areas (AOR=2.61, 95% CI: 1.10-6.18), fear regarding drug safety (AOR=3.19, 95% CI: 1.56-6.54), duration of ART (<5 years) (AOR=2.45, 95% CI: 1.17-5.16), need for frequent checkups (AOR=2.70, 95% CI: 1.29-5.61), poor understanding of ASM (AOR=3.15, 95% CI: 1.54-6.43), high perceived difficulties of engagement in ASM (AOR=10.13, 95% CI: 4.31-23.84), perceived presence of high opportunistic cost (AOR=3.34, 95% CI: 1.64-6.83), low self-efficacy (AOR=7.44, 95% CI: 3.16-17.46), recent history of opportunistic infection (AOR=3.34, 95% CI: 1.64-6.83), absence of competing family activities (AOR=4.39, 95% CI: 2.05-9.44) and stigma (AOR=2.85, 95% CI: 1.39-5.81).
The majority of factors affecting ASM non-utilization were behavioral and community related, which can be addressed by health education both at client and community level and additionally, by training service providers to address factors connected with the provision of service. Qualitative study and impact assessment on client retention are recommended for further research.
埃塞俄比亚目前正在实施抗逆转录病毒治疗（ART）的预约间隔模式（ASM）。在6家试点ASM的医院进行的一项研究表明，51%符合条件的客户拒绝了ASM。关于ASM的研究主要集中在其益处上，而非决定其使用情况的因素。本研究旨在确定ASM未被使用的决定因素。
确定稳定的ART客户中ASM未被使用的决定因素。
在194例病例和194例对照中开展了一项非匹配病例对照研究，研究对象为吉姆马镇四家公共卫生机构中连续入选的接受抗逆转录病毒治疗（ART）的稳定客户。通过面对面访谈和观察技术，使用半结构化问卷和观察清单收集数据。分别使用EpiData 3.1版和SPSS 23版进行数据录入和分析。描述性统计、逻辑回归、调整优势比和95%置信区间分别用于汇总描述性数据、确定ASM未被使用的决定因素、衡量统计关联强度以及宣布统计显著性。
在100%的应答率下，ASM未被使用的预测因素包括居住在城市地区（优势比=2.
