Changing the recipe: patient-initiated changes to antiretroviral therapy regimens among Latinos living in the U.S.-Mexico border region
M.L. Zúñiga1, E. Blanco1, J. Kozo1, L.M. Pachter2, R. Scolari3, S.A. Strathdee1
1University California San Diego, Division of Global Public Health, Department of Medicine, San Diego, United States, 2St. Christopher's Hospital for Children, Philadelphia, United States, 3San Ysidro Health Center, San Ysidro, United States
Background: We explored factors associated with patient initiated decisions to make changes to their ART regimen among HIV-positive Latinos in the US-Mexico border region.
Methods: A cross-sectional study was conducted with HIV-positive participants from HIV social/clinical service agencies in Tijuana and San Diego. Logistic regression examined factors associated with small and large patient-mediated ART regimen changes (“made changes” vs. “did not make changes”).
Results: Among 179 Latinos, no significant differences were found between U.S. and Mexican residents. Most were male (73%), single/separated/divorced (60%), gay/lesbian (50%) and had less than high school education (57%). Half (51%) made at least one round-trip border crossing in the last 6 months. Most (72%) reported medical coverage in US or Mexico and 26% coverage in both countries. Most (91%) had at least one HIV-related medical visit in the last 6 months. Over 90% believed ARTs are effective and 86% rated their provider relationship favorably. In the last 4 weeks, 40% made small changes to their ARV regimen and 19% made major changes, and almost all respondents (92%) reported that they did not stop taking ARTs because of side effects. In the last week, only 67% reported that they had been able to take their ARTs exactly as their doctor/ nurse told them to do. Logistic regression revealed that female participants were significantly more likely to report major ART regimen changes (adjOR=2.3 95%CI :1.04-5.00).
Conclusions: High treatment optimism, medication tolerance, and satisfaction with patient/provider relationships are positive indicators of better patient health, including patient disposition to seek HIV care and adherence to ART as prescribed. Self-reported changes in ART, especially among women in the US-Mexico border region are of concern. Improved understanding of patient decisions to alter ARV regimens, including the nature and frequency of changes, is warranted in order to guide patient-centered clinical discussions about ART adherence.
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