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Sociodemographic profile and predictors of outpatient clinic attendance among HIV-positive patients initiating antiretroviral therapy in Selangor, Malaysia

机译：马来西亚雪兰莪州开始抗病毒治疗的HIV阳性患者的社会人口统计学特征和门诊就诊预测指标

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Background: 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. Patients and methods: 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. Results: 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]; P =0.030) and heterosexual orientation (AOR =4.199; 95% CI [1.040–16.957]; P =0.044) were significant predictors of outpatient clinic attendance among HIV-positive patients receiving ART in Malaysia. Conclusion: 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.
机译：背景：不一致的文献证据表明，在全球接受抗逆转录病毒治疗（ART）的HIV阳性人群中，社会人口统计学，经济因素以及与系统和患者相关的因素与临床就诊率相关。我们检查了在马来西亚雪兰莪州发起抗逆转录病毒治疗的一组艾滋病毒阳性患者中预测门诊就诊的因素。患者与方法：这项横断面研究分析了马来西亚雪兰莪州242名开始接受抗逆转录病毒治疗的成年马来西亚患者的门诊就诊以及社会人口统计学，经济，社会心理及患者相关因素的辅助数据。研究队列于2014年1月至12月在马来西亚双溪毛糯医院参加了一项家长随机对照试验（RCT），在此期间，通过短信服务（SMS）和电话向干预小组提供了同伴咨询，药物治疗和诊所任命提醒连续24周致电。门诊就诊数据是从医院电子病历系统中提取的，而其他患者水平的数据是从预先验证的成人艾滋病临床试验组（AACTG）依从性调查表中提取的，该调查表中收集了主要数据。根据六个月内未按计划安排的门诊预约数量，将门诊就诊分为二类结果-常规出席者和违约者类别。使用SPSS 22版和R软件对多元回归模型进行拟合，以检查门诊就诊的预测因素。结果：该模型包括总共224名（93％）完成6个月评估的患者。在这些人中，有42人（18.7％）至少一次违约了预定的诊所出诊时间。错过约会的比例在女性（n = 10，37.0％），农村居民（n = 10，38.5％）和双性恋者（n = 8，47.1％）中更为普遍。多元二元logistic回归分析显示，印度种族（调整后的优势比[AOR] = 0.235; 95％CI [0.063-0.869]; P = 0.030）和异性恋倾向（AOR = 4.199; 95％CI [1.040-16.957]; P = 0.044）是马来西亚接受ART的HIV阳性患者中门诊就诊人数的重要预测指标。结论：马来西亚患者的种族和性取向可能在其遵守预定诊疗预约的水平上起重要作用。在ART发起时的协作依从性策略规划中应考虑这些因素。

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