Adherence to antiretroviral therapy among HIV/ AIDS patients in the context of early treatment initiation in Vietnam

Detection of Antiretroviral Drug-Resistant Mutations and HIV-1 Subtypes in Circulation Among Men Who Have Sex With Men, SEM Females, and Female Sex Workers: Results of Vietnam's HIV Sentinel Surveillance Plus System, 2018-2020

BACKGROUND

HIV drug resistance can reduce the effectiveness of antiretroviral drugs in preventing morbidity and mortality, limit options for treatment, and prevention. Our study aimed to assess HIV-1 subtypes and HIV drug resistance among key populations in HIV Sentinel Surveillance Plus Behavior in 2018 and 2020.

METHODS

One-stage venue-based cluster sampling was used to recruit participants at hotspots identified for men who have sex with men (MSM) in 7 provinces and sexual minority females and female sex workers (FSW) in 13 provinces. Participants completed a standard questionnaire about risk and preventive behaviors, and antiretroviral therapy history, and provided intravenous blood for HIV testing. HIV drug resistance testing was conducted on HIV-positive samples with viral load >1000 copies/mL.

RESULTS

A total of 185 of 435 (42.5%) HIV-positive samples had viral load ≥1000 copies/mL, of which 130 of 136 from MSM and 26 of 49 from FSW were successfully sequenced. Six HIV-1 subtypes were detected (CRF01_AE, A, CRF07/08_BC, B, C, CRF25_cpx), with CRF01_AE (82.7%, 129/156) the most common. Drug resistance mutations were detected in 16.7% of participants overall (26/156), in 15.4% (20/130) of MSM, and in 23.1% (6/26) of FSW. Mutations associated with resistance to non-nucleoside reverse transcriptase inhibitor (NNRTI) were the most frequently detected (73.1%, 19/26). The high level of resistance was presented in NNRTI and nucleoside reverse transcriptase inhibitors classes. There are 10 major resistance mutations detected with nucleoside reverse transcriptase inhibitors (M184VI-25.0%, K65KR-50.0%, Y115F-25%), NNRTI (K103N-21.1%, E138A-10.5%, V106M-5.3%, K101E-5.3%, G190A-5.3%), protease inhibitors (L33F-40.0%, M46L-20.0%).

CONCLUSIONS

Vietnam's HIV Sentinel Surveillance Plus system identified an emerging strain of HIV-1 and mutations associated with resistance to multiple drug classes among MSM and FSW.

Antiretroviral therapy non-adherence and its relationship with cognitive impairment, alcohol use disorder, and depression in adolescents living with HIV

OBJECTIVE

We aimed to compare antiretroviral non-adherence in the behaviourally infected (BIAs) and congenitally infected adolescents (CIAs) and explore its associations with depression, cognitive impairment, and alcohol use disorder (AUD) in adolescents living with HIV(ALWHIV) in Botswana.

METHODS

This study was a cross-sectional, comparative, multi-center research that involved collecting samples from different HIV clinics in Botswana. Of the 622 ALWHIV, 223 were identified as BIAs and 399 as CIAs. They were evaluated using various tools such as MINI-KID for psychiatric disorders, DSM-5 for AUD, CAT-rapid for cognitive assessment, and Visual Analogue Scale (VAS) for non-adherence (the outcome). The data were analysed using both bivariate and multivariate regression analyses.

RESULTS

The participants' mean age (SD) was 17.7(1.60). The CIAs were more likely to have cognitive impairment (t -7.25; p < 0.01), while the BIAs had more depression (χ2 = 5.86; p = 0.016) and AUD (χ2 = 4.39; p = 0.036) and were more likely to be non-adherent (t = 3.14; p = 0.002). In the CIA group, cognitive impairment (AOR = 2.86; 95% CI:1.77-4.64) (AOR = 2.79; 95%CI:1.73-4.48) and depression (AOR = 2.69; 95%CI:1.48-4.90 were associated with ART non-adherence. In the BIA group, depression (AOR = 2.55; 95%CI:1.27-5.16), AUD (AOR = 2.58; 95%CI:1.21-5.49) and struggling to accept status (AOR = 2.54; 95%CI:1.41-4.56) predicted non-adherence to treatment.

CONCLUSION

The two groups of adolescents differ regarding ART non-adherence and associated psychosocial issues, indicating the need for differentiated care to address non-adherence in the ALWHIV, especially in high-burden, resource-constrained settings, such as Botswana.

What are the determinants of antiretroviral therapy adherence among stable people living with HIV? A cross-sectional study in Cambodia

BACKGROUND

Understanding context-specific determinants of antiretroviral therapy (ART) adherence is crucial for developing tailored interventions for improving health outcomes and achieving the UNAIDS' third 95% target. This cross-sectional study explores factors associated with ART adherence among stable people living with HIV on ART in Cambodia.

METHODS

We used baseline survey data from a quasi-experimental study conducted in 2021. The participants were recruited from 20 ART clinics in nine provinces for face-to-face interviews. A structured questionnaire collected information on sociodemographic characteristics, ART adherence, perceived ART self-efficacy, mental health, quality of life, stigma, and discrimination. We conducted bivariate and multiple logistic regression analyses to identify factors associated with ART adherence.

RESULTS

Out of the 4101 participants, 86.5% reported adhering to ART in the past two months. The adjusted odds of ART adherence were significantly higher among participants in older age groups than those aged 15-29, participants with elevated cholesterol than those without it, participants who exhibited strong self-efficacy in health responsibility to maintain life than those with poor self-efficacy in health responsibility, participants who scored < 3 on the stigma and discrimination scale than those who scored ≥ 3, participants who scored ≥ 42 on the mental component of the quality-of-life scale than those who scored < 42. The adjusted odds of ART adherence were significantly lower in participants who earned > 301 USD per month than those who earned ≤ 100 USD per month.

CONCLUSION

The ART adherence rate among stable people living with HIV in this study was comparable to that of the general people living with HIV in Cambodia. The results suggest the need for innovative interventions to further reduce stigma and discrimination and strategies to improve the self-efficacy and mental health of people living with HIV to improve ART adherence.

The effectiveness of psychoeducation and problem-solving on depression and treatment adherence in adolescents living with HIV in Botswana: an exploratory clinical trial

BACKGROUND

This study aimed to explore the effectiveness of psychological interventions (PI): psychoeducation, problem-solving, and rehearsal strategies on depression and adherence in HIV-infected adolescents in Botswana.

METHODS

Fifty adolescents living with HIV were randomized into control (n = 25) and intervention groups (n = 25), the latter being exposed to five weeks of PI sessions. The PHQ-9 and visual analog scale (VAS) were used to measure the outcomes: depression and adherence at pre-intervention, 5- and 24 weeks post-intervention.

RESULTS

The participants' mean age (SD) was 17.38 years (1.1), the two groups being similar in socio-demographic variables: gender (χ² = 2.22; p = 0.135) and age (U = 285, z =  - 0.55, p = 0.579). The intervention group scored significantly lower on depressive symptoms (PHQ-9 [F (1,50) = 12.0, p = 0.001, ƞ_p² = 0.20]) and higher on adherence score (VAS [F (1,50) = 13.5, p = 0.001, ƞ_p² = 0.22]) than the control group after 5 weeks. The post-hoc analysis showed that the significant improvements in depressive symptoms (z =  - 4.03, p < 0.01, r [effect size] = 0.88) and adherence (z =  - 4.05, p < 0.01, r = 0.88) at post-test in the intervention group were maintained at 24 weeks. This project was registered with ClinicalTrials.gov (NCT05482217).

CONCLUSION

The 5-week PI showed promising effectiveness in addressing depression and adherence in adolescents living with HIV in Botswana.

A model for explaining adherence to antiretroviral therapy in patients with HIV/AIDS: A grounded theory study

Maintaining a high level of adherence to antiretroviral therapy is a challenge among HIV/AIDS patients. The study aimed to explore the process of adherence to treatment with a grounded theory approach to help physicians and planners develop strategies to increase adherence to treatment. We conducted in-depth interviews and a focus-group discussion. The data were collected from 2016 to 2018. The participants were 39 HIV/AIDS patients treated with antiretroviral, their relatives (three people) and two treatment staff. The study was conducted at the Behavioural Counselling Center of Imam Khomeini Hospital, located in Tehran, the capital of Iran. The data were analysed at the stages of "analysis for concepts," "analysis for context," "bringing process into the analysis" and "integrating." We obtained a conceptual model to explain the relationship between the categories. "Motivation" was identified as the core variable and the "Becoming resilient" explained the adherence process. Several factors including the interfering factors, contextual factors and resilience factors were identified. The interfering and contextual factors, in the absence of the resilience factors, lead to decreased motivation and increased poor adherence to treatment. The role of motivation in long-term adherence should be emphasised. We think strategies such as helping individuals with HIV/AIDS to form support networks, empowering and encouraging them to seek spiritual help will motivate them to maintain a long-term use of antiretroviral medications and, hence, become more resilient.

Cost and Cost-Effectiveness of Incentives for Viral Suppression in People Living with HIV

Only 63% of people living with HIV in the United States are achieving viral suppression. Structural and social barriers limit adherence to antiretroviral therapy which furthers the HIV epidemic while increasing health care costs. This study calculated the cost and cost-effectiveness of a contingency management intervention with cash incentives. People with HIV and detectable viral loads were randomized to usual care or an incentive group. Individuals could earn up to $3650 per year if they achieved and maintained an undetectable viral load. The average 1-year intervention cost, including incentives, was $4105 per patient. The average health care costs were $27,189 per patient in usual care and $35,853 per patient in the incentive group. We estimated a cost of $28,888 per quality-adjusted life-year (QALY) gained, which is well below accepted cost-per-QALY thresholds. Contingency management with cash incentives is a cost-effective intervention for significantly increasing viral suppression.

Barriers and facilitators of adherence to antiretroviral treatment at a public health facility in Ghana: a mixed method study

BACKGROUND

HIV/AIDS is a disease of global public health concern with high morbidity and mortality rates. Poor adherence to antiretroviral therapy (ART) increases the risk of viral drug resistance and reduces treatment effectiveness towards viral suppression leading to disease progression, greater risk of death and increased risk of viral transmission. The study sought to assess current adherence levels to ART among patients in Ghana, exploring barriers and enablers of adherence to it, to provide future guidance to all key stakeholder groups.

METHOD

A mixed method approach was used comprising of a cross-sectional survey of patients followed by a focused group discussion with patients and an in-depth interview of four key health professionals working in the ART clinic of Atua Government Hospital, a primary care health facility in the Eastern Region of Ghana. A structured questionnaire was used to assess current adherence levels and their determinants among 231 randomly selected patients attending the clinic between July to September, 2019. Quantitative data were analysed using bivariate and multivariate methods while qualitative data were analysed using thematic framework approach.

RESULTS

Adherence levels was found to be 42.9% among our study population. Lower adherence to ART was associated with patients' belief in herbal medicine (aOR =0.34 CI: 0.19-0.61). Other barriers identified from the qualitative analysis included low motivation arising from pill fatigue, forgetfulness, frequent stock out of medicines, long waiting times and worrying side-effects; while enablers, on the other hand, included measures that ensure improved assessment of adherence and health facility-related activities that improve patient satisfaction with ART services. Conclusion: Adherence to ART among patients living with HIV was sub-optimal in our study population. Understanding of the barriers and factors that enable adherence to ART is a key step to developing evidence-based adherence improvement strategies to enhance clinical outcomes.

Effects of substance use on monetary delay discounting among people who use stimulants with and without HIV: An ecological momentary assessment study

Exploration of the real-time relationship between substance use and delay discounting may reveal potential mechanisms driving high-risk behaviors. We conducted an ecological momentary assessment (EMA) study to investigate the effects of substance use on delay discounting in a sample of people who use stimulants (HIV+: 30; HIV-: 34). Participants completed multiple EMAs throughout the day for 28 days. The EMAs collected data on delay discounting and substance use (time since last substance use and level of intoxication). Delay discounting was assessed using a brief Monetary Choice Questionnaire (MCQ). Analyses were conducted using linear mixed effects modeling. Most participants (99.1%) used cocaine as their primary stimulant. Among participants without HIV, MCQ score remained relatively stable during the first 2 hr after stimulant use, followed by an increase during 2-6 hr (p < .05), before decreasing again. For alcohol and marijuana, the MCQ score was stable during the first 4 hr after use, with a sharp increase at 4-6 hr (p < .05), before decreasing again. Among participants with HIV, there were no changes in MCQ score as a function of time since recent substance use. These findings provide evidence of a plausible connection between delay discounting and acute withdrawal that may have relevance for risky behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Using mobile health technologies to test the association of cocaine use with sexual desire and risky sexual behaviors among people with and without HIV who use illicit stimulants

BACKGROUND

Cocaine use is broadly associated with risky sexual behavior potentially through elevated sexual desire. Understanding the within-person effects of cocaine on sexual desire and risky sexual behavior and the modification of HIV infection may inform primary and secondary HIV interventions.

METHODS

We conducted a mobile health (mHealth) study in a community sample of males and females with (n = 28) and without (n = 32) HIV who use illicit stimulant drugs. Participants completed ecological momentary assessments (EMAs) and daily diaries over 28 days. Mixed effects models were employed to examine the within-person association of cocaine use with sexual desire and risky sexual behavior.

RESULTS

Participants completed 3505 EMA responses, with 36 % involving recent cocaine use, including powder and/or crack cocaine. They completed 1427 daily diary responses, with cocaine use reported on 49 % of these days and sexual behavior on 21 % of these days. Sexual desire was highest in the first hour since cocaine use and gradually decreased with time. Sexual desire was lowest when participants had not used any cocaine in the past 6 h, and it correlated positively with the amount of use. Participants were more likely to have risky sexual behavior on days they used cocaine. These associations were similar for participants with and without HIV.

CONCLUSION

This study demonstrates the dynamic and proximal effects of cocaine use on sexual desire and risky sexual behavior. Our findings support the development of HIV prevention interventions that utilize mHealth technology to reduce sexual risk behavior among persons who use stimulant drugs.

Survival Outcomes of Vietnamese People with HIV after Initiating Antiretroviral Treatment: Role of Clinic-Related Factors

Given the rapid development of HIV clinics in Vietnam, this study evaluates the infrastructure surrounding this expansion, identifying clinic-related factors that impact survival outcomes. A retrospective longitudinal study was conducted among people living with HIV (PLWH) who initiated antiretroviral therapy (ART) between 2011 and 2015 among 62 ART clinics in 15 provinces. The mortality rate during the 717674.1 person-years of observation (PYO) was 0.29/100 PYO. Location in rural areas (versus urban) and in Central Vietnam (versus Northern Vietnam) were associated with higher risk of mortality. The risk was lower among clinics that had peer-educators. As Vietnam's HIV/AIDS program continues to expand, this data supports increasing resource allocation for rural clinics, incorporation of ART with the community's existing healthcare infrastructure in its efforts to decentralize, and integration of services to reflect patients' anticipated needs.

Smartphone Use and Willingness to Pay for HIV Treatment-Assisted Smartphone Applications among HIV-Positive Patients in Urban Clinics of Vietnam

This study aimed to examine the effectiveness of Human Immunodeficiency Virus (HIV)-assisted smartphone applications in the treatment of HIV/AIDS patients in Vietnam. A cross-sectional study was performed in two urban outpatient clinics in Hanoi from May to December 2019. A simple random sampling method and a structured questionnaire were used to recruit 495 eligible participants and to collect data. Multivariable modified Poisson regression and multivariable linear regression models were employed to investigate the factors associated with the willingness to pay (WTP) and amount of money patients were willing to pay. Approximately 82.8% of respondents were willing to pay for the hypothetical applications, with the mean amount the participants were willing to pay of Vietnam Dong (VND) 72,100/month. Marital status (separate/divorced/widow: Odds ratio (OR) = 1.28, 95% confidence interval (CI) = (1.09; 1.50) and having spouse/partner: OR = 1.18, 95% CI = (1.03; 1.36)) and using health services (OR = 1.03, 95% CI = (1.01; 1.04)) were positively associated with nominating they would be WTP for the app, whereas the duration of antiretroviral treatment (ART) (OR = 0.98, 95% CI = (0.96; 0.99)) had a negative association. The frequency of using health services (β = 0.04, 95% CI = (−0.07; −0.01)) was negatively associated with the amount of WTP. High levels of WTP revealed the feasibility of implementing smartphone-based apps for HIV treatment. This study implied the necessity to consider a co-payment system to reach populations who were in need but where such applications may be unaffordable in lieu of other treatment-associated expenses. Developers also need to pay attention to privacy features to attract single people living with HIV/AIDS and additional measures to initiate people with a long duration on ART into using the applications.

HIV/AIDS treatment funding system to support the people affected by HIV/AIDS in Surakarta, Indonesia

People Living with HIV/AIDS (PLWHA's) quality of life (QoL) is determined by the lifetime treatment sustainability. Republic of Indonesia Minister of Health's Decree Number 328 of 2003 stated that government subsidies the PLWHA's medication and treatment, despite not covering entire medication and treatment cost. The objective of research was to analyse the cost assumed by PLWHA in accessing HIV/AIDS treatment service in Surakarta, Indonesia. The target group in this case study was PLWHAs, and related stakeholders of medical treatment in one of Public Health Centers and a Public Hospital in Surakarta; AIDS Commission of Surakarta City; Solo Plus Peer Support Group and AIDS-Care NGO selected purposively. Data collection was carried out using observation, in-depth interview, and documentation. Method and data source triangulations were used to validate data that was then analysed using Grossman's Demand for Health Capital theory. The result of research showed that the sources of HIV/AIDS treatment cost were self-income, Social Insurance Administration Organization (BPJS) fund and Local Government subsidy. Admission and physican services are given for free to PLWHA because it has been paid by BPJS Fund or has been subsidied by Local Government. Otherwise, they should pay registration cost of IDR 50,000, in Public Hospital and IDR 75,000 in Private Hospital. Physician service costs IDR 50,000–IDR 200,000. VCT Counsellor costs IDR 35,000-IDR 150,000. Non-Subsidy ARV costs IDR 687,000. 1 bottle containing 60 TB meningitis drug capsules costs IDR 145,000 for 10–20 d use and maximally IDR 210,000, while herpes drug costs IDR 295,000. CD4 examination costs IDR 126,000-IDR 297,000, RNA Viral load IDR 1,275,000–IDR 1,471,000, Haematology IDR 60,000-IRD 90,000, Cholesterol and triglyceride IDR 100,000-IDR 250,000, and SGOT/SGPT IDR 100,000–IDR 200,000. There is monthly non-medical cost the patient should spend, including transportation cost to go to health centre, and food, beverage, and newspaper cost while waiting for the service. BPJS fund and local government subsidy relieved health economic burden of PLWHAs, so that the average HIV/AIDS treatment cost in PLWHAs was relatively low, less than 10% of expense. National Insurance System including BPJS fund and local government subsidy as the answer to the integration of HIV/AIDS treatment funding management into national insurance system had provided PLWHA a funding access involving prevention, care, support, and treatment, and mitigated the effect despite less optimum.

An update on drug-drug interactions between antiretroviral therapies and drugs of abuse in HIV systems

INTRODUCTION

While considerable progress has been made in the fight against HIV/AIDS, to date there has not been a cure, and millions of people around the world are currently living with HIV/AIDS. People living with HIV/AIDS have substance abuse disorders at higher rates than non-infected individuals, which puts them at an increased risk of drug-drug interactions.

AREAS COVERED

Potential drug-drug interactions are reviewed for a variety of potential drugs of abuse, both licit and illicit. These drugs include alcohol, cigarettes or other nicotine delivery systems, methamphetamine, cocaine, opioids, and marijuana. Potential interactions include decreased adherence, modulation of drug transporters, or modulation of metabolic enzymes. We also review the relative incidence of the use of these drugs of abuse in People living with HIV/AIDS.

EXPERT OPINION

Despite considerable improvements in outcomes, disparities in outcomes between PLWHA who use drugs of abuse, vs those who do not still exist. It is of critical necessity to improve outcomes in these patients and to work with them to stop abusing drugs of abuse.

Adherence to antiretroviral therapy among HIV seropositive patients in northern Greece. Major factors of influence

BACKGROUND

Adherence to HIV antiretroviral therapy (ART) is of great importance for reducing viral load and the eventual treatment of the patients and minimizing infectivity. This study aimed to investigate adherence to ART among people living with HIV in northern Greece and investigate the factors influencing adherence to ART.

METHODS

A correlational study was performed on a cohort of 112 seropositive individuals (100 men and 12 women) with a mean age of 37.14 years. The simplified medication adherence questionnaire (SMAQ) was used to assess adherence. In addition, the perceived available support questionnaire (PAS) for social support assessment was utilized to evaluate the perceived social support.

RESULTS

Approximately 60% of patients were found to be nonadherent to ART. Important factors affecting adherence are educational level, social support, and use of substances.

CONCLUSIONS

The results show that a significant proportion of the cohort of patients investigated from northern Greece does not show adherence to ART. Several factors were identified to be of significant influence, which should be taken into consideration by the Greek healthcare providers. HIPPOKRATIA 2020, 24(3): 114-119.

Factors associated with high-risk behaviors of people newly diagnosed with HIV/AIDS: results from a cross-sectional study in Vietnam

Towards the elimination of this global epidemic, understanding the high-risk behaviors of people newly diagnosed with HIV/AIDS (PNDWH) is essential. This study aimed to describe the general characteristics and high-risk behaviors of PNDWH and identify associated factors for adopting high-risk behaviors. A cross-sectional survey was conducted in Vietnam to explore the high-risk behaviors of 506 PNDWH. Associated factors were identified using multivariable logistic regressions. 83.2% of participants had sex without using a condom, and 27.9% had more than two sex partners. Among injected drug users, 44% had shared needles with an average number of 2.1 shared partners. Male, Kinh ethnicity (Vietnamese), high income, and high educational level were risk factors for high-risk behaviors. Our findings revealed the first time a comprehensive picture of PNDWH and emphasized the high prevalence of STIs, including untreated STIs and the long delay since the early HIV diagnosis. Also, our model found much higher risk behaviors among participants who were non-adherent to ART and those currently enrolled in ART. By better managing newly-diagnosed cases, better integrating STI management services and prevention consultants, as well as improving ART adherence programs, Vietnam can make better progress towards the complete control of HIV for its most vulnerable populations.

Factors Associated With Adherence To Anti-Retroviral Therapy Among People Living With HIV/AIDS At Wangaya Hospital In Denpasar, Bali, Indonesia: A Cross-Sectional Study

Background

Acquired Immunodeficiency Syndrome (AIDS) is a major public health problem. Recently AIDS was considered as a manageable chronic disease. High adherence to Anti-Retroviral Therapy (ART) is necessary to achieve undetectable viral load, reduce morbidity, mortality and to improve the quality of life. It is also preventing the drug resistance, reducing the transmission and finally leading to live longer and healthier.

Objectives

To assess the factor associated with ART adherence among people living with HIV/AIDS (PLWHA) at Wangaya Hospital, in Denpasar, Bali, Indonesia.

Methodology

A cross-sectional study was carried out during January 2015–December 2017 among 202 PLWHA taking ART for at least 6 months. The participants were interviewed using a semi-structured questionnaire to obtain data on socio-demographic characteristics. The data were analyzed using SPSS software for windows version 24.0. Chi-square test was done, the precision value of 95% (p<0.05) was considered statistically to be significant.

Results

A total of 202 PLWHA taking ART, 170 (84.16%) were reported with high adherence (≥95%), 32 (15.84%) were low adherence (<95%). Factors found to be independently associated with high adherence to ART were employment status/occupation (p = 0.011), type of ARV (due to adverse effect of ART) (p = 0.002) and family support (p < 0.001).

Conclusion

This study found that the factor associated with ART adherence among PLWHA who visited Wangaya Hospital, in Denpasar, Bali, Indonesia, was employment status, type of ARV and family support.

A global bibliometric analysis of antiretroviral treatment adherence: implications for interventions and research development (GAPRESEARCH)

The introduction of antiretroviral therapy (ART) has helped HIV population to live longer, but they could face not only AIDS-related morbidity but also other non-communicable diseases. Paying attention to ART adherence requires a system thinking with the life-long factors, individual-environment interactions and contextualized dynamics. Although several quantitative research had been conducted, they were not able to fully demonstrate the development of research approaches and scopes of previous studies. Essential and practical public health policy should be based on the most accessible and strategically analyzed evidence. Therefore, our study uses a scientometric approach to supplement previous reviews research covering until the end of 2017. Using a combination of two quantitative approaches to supplement previous reviews, we attempt to identify the research trends and potential research gaps which could be very helpful for policies and practices enhancements to inform evidence-based strategies. Our result indicates countries tend to collaborate in traditional models rather than prioritize severity and characteristics of HIV epidemics. Further ART research should highlight the incorporation of newly developed technology to examine long-term impacts, combine multiple measures, address contextual factors, and involve available technologies and resources, e.g., family, community.

Factors Associated with Improved HIV/AIDS Treatment Outcomes: Comparing two Major ART Service Delivery Models in Vietnam

A mixed design approach was performed to assess the CD4 count levels over time and their associated factors among 362 HIV patients on ART from clinics with HIV testing and counseling (ART-HTC) services and those with general healthcare (ART-GH) services. Longitudinal CD4 count data were retrospectively collected from medical records. Sociodemographic, clinical, alcohol use and smoking characteristics were obtained via face-to-face interviews. Multivariate mixed effect linear regression was utilized to determine the association. We found that HIV patients at ART-GH clinics were more likely to achieve higher CD4 counts over time compared to patients at ART-HTC clinics. Additionally, having an increase in CD4 counts was found to be associated with having longer duration of ART and higher baseline CD4 levels. Cigarette smoking and hazardous alcohol use, however, were not associated with CD4 count improvement. Our findings suggest that combining HTC and GH services might provide a synergistic benefit in ART treatment outcomes through an improved access to comprehensive HIV healthcare services for HIV patients on therapy.