Adherence to PI-based 2nd line regimens in Cambodia is not simply a question of individual behaviour: the ANRS 12276 2PICAM study

Objectives To investigate whether adherence to antiretroviral treatment (ART) can be explained not only by individual factors but also by healthcare facilities’ characteristics, among a sample of people living with HIV (PLWH) treated with PI-based regimens in Cambodia. Methods The ANRS 12276 2PICAM cross-sectional survey was conducted between February 2013 and April 2014 among PLWH followed up in 13 healthcare facilities. The 1316 patients in this analysis corresponded to 90% of the total number of adult patients treated with 2nd line PI-based regimens in Cambodia in the study period. A variable indicating whether patients were non-adherent (=1) or completely adherent (=0) was constructed. Healthcare facilities and individual characteristics were included in a two-level logistic model to investigate their influence on patients’ adherence to ART. Results 17% of participants did not adhere to ART. Patients in healthcare facilities outside the capital Phnom-Penh were six times more likely to be non-adherent than those treated in healthcare facilities in the capital (OR: 6.15, 95%CI[1.47, 25.79]). Providing psychosocial care (provided by psychologist counsellors and/or full-time coaches) was found to be a structural facilitator of adherence, as the probability of non-adherence fell by 38.5% per each additional psychological worker present in healthcare facilities (OR:0.62, 95%CI[0.43, 0.89]). Financial constraints were the main individual factor preventing adherence. Conclusions Our results suggest that inefficiencies in healthcare delivery are detrimental to PLWH health and to the exceptional progress currently being made by Cambodia in response to HIV. Policy makers should focus on increasing the number of psychosocial workers, especially in areas outside the capital. This article is protected by copyright. All rights reserved.