Seleman Khamis Semvua1, Christine Yaeree Kim2, Charles Muiruri3, Timothy Antipas Peter4, Blandina T Mmbaga5, John A Bartlett6, Leah L Zullig7, Shelley A Jazowski8, Brandon A Knettel9, Francis P Karia10, Habib O Ramadhani11. 1. Seleman K. Semvua, Kilimanjaro Christian Medical University College, Moshi, Tanzania;, Email: semvua006@yahoo.com. 2. Christine Yaeree Kim, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States, and Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States. 3. Charles Muiruri, Kilimanjaro Christian Medical University College, Moshi, Tanzania, and Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States, and Duke Global Health Institute, Duke University, Durham, NC, United States. 4. Timothy Antipas Peter, Kilimanjaro Christian Medical University College, Moshi, Tanzania. 5. Blandina T. Mmbaga, Kilimanjaro Christian Medical University College, Moshi, Tanzania, and Duke Global Health Institute, Duke University, Durham, NC, United States. 6. John A. Bartlett, Kilimanjaro Christian Medical University College, Moshi, Tanzania, and Duke Global Health Institute, Duke University, Durham, NC, United States. 7. Leah L. Zullig, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States, and Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States. 8. Shelley A. Jazowski, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States, and Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States. 9. Brandon A. Knettel, Duke Global Health Institute, Duke University, Durham, NC, United States, and School of Nursing, Duke University, Durham, NC, United States. 10. Francis P. Karia, Kilimanjaro Christian Medical University College, Moshi, Tanzania, and Duke Office of Clinical Research. Duke University School of Medicine, Durham, NC, United States. 11. Habib O. Ramadhani, Kilimanjaro Christian Medical University College, Moshi, Tanzania, and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States.
Abstract
Objectives: In this study, we explored determinants of "researcher-observed" patient-initiated antiretroviral therapy (ART) repackaging practices among people living with HIV (PLHIV) in Northern Tanzania. Methods: We used a quasi-experimental design to describe the prevalence of ART self- repackaging; we conducted face-to-face surveys to determine factors associated with ART self- repackaging practices. Data collection sites included the Kilimanjaro Christian Medical Centre and the Mawenzi Referral Hospital. We used study-specific numerical identifiers assigned to ARTs packaging to determine self-repackaging behavior. Self-repackaging was defined as a binary variable where participants who discarded antiretroviral drugs packaging in at least 2 clinic visits were classified as self- repackagers. We used multivariable logistic regression to assess the determinants of patient-initiated repackaging practices. Results: Among 590 study participants, 57.6% self-repackaged based on researcher observation and 55.6% self-repackaged based on patient report. Researcher-observed self- repackaging was associated with gender (AOR = 1.590; 95% CI: 1.011, 2.502), employment status (AOR = 0.475: 95% CI; 0.239, 0.942), and study site (AOR = 0.218; 95% CI: 0.134, 0.355). Conclusions: A substantial proportion of patients self-repackage their ARTs for various reasons. Health system interventions should focus on addressing the attributes of repackaging among men and unemployed patients.
Objectives: In this study, we explored determinants of "researcher-observed" patient-initiated antiretroviral therapy (ART) repackaging practices among people living with HIV (PLHIV) in Northern Tanzania. Methods: We used a quasi-experimental design to describe the prevalence of ART self- repackaging; we conducted face-to-face surveys to determine factors associated with ART self- repackaging practices. Data collection sites included the Kilimanjaro Christian Medical Centre and the Mawenzi Referral Hospital. We used study-specific numerical identifiers assigned to ARTs packaging to determine self-repackaging behavior. Self-repackaging was defined as a binary variable where participants who discarded antiretroviral drugs packaging in at least 2 clinic visits were classified as self- repackagers. We used multivariable logistic regression to assess the determinants of patient-initiated repackaging practices. Results: Among 590 study participants, 57.6% self-repackaged based on researcher observation and 55.6% self-repackaged based on patient report. Researcher-observed self- repackaging was associated with gender (AOR = 1.590; 95% CI: 1.011, 2.502), employment status (AOR = 0.475: 95% CI; 0.239, 0.942), and study site (AOR = 0.218; 95% CI: 0.134, 0.355). Conclusions: A substantial proportion of patients self-repackage their ARTs for various reasons. Health system interventions should focus on addressing the attributes of repackaging among men and unemployed patients.
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