ANTIRETROVIRAL THERAPY (ART) ADHERENCE among People Living with HIV/AIDS (PLHIV) in the North of Vietnam: a Multi-method Approach Hoa Mai Do MD, MPH A thesis submitted for the degree of Doctor of Philosophy at the School of Public Health, Faculty of Health, and Institute of Health and Biomedical Innovation, Queensland University of Technology 2011 KEYWORDS HIV/AIDS Antiretroviral Therapy Antiretroviral Therapy adherence Antiretroviral People Living with HIV/AIDS HIV/AIDS patient Multi-method/mixed method Audio Computer-Assisted Self-Interview Viet Nam Level Prevalence Factors Correlates i ii ABSTRACT The antiretroviral therapy (ART) program for People Living with HIV/AIDS (PLHIV) in Vietnam has been scaled up rapidly in recent years (from 50 clients in 2003 to almost 38,000 in 2009) ART success is highly dependent on the ability of the patients to fully adhere to the prescribed treatment regimen Despite the remarkable extension of ART programs in Vietnam, HIV/AIDS program managers still have little reliable data on levels of ART adherence and factors that might promote or reduce adherence Several previous studies in Vietnam estimated extremely high levels of ART adherence among their samples, although there are reasons to question the veracity of the conclusion that adherence is nearly perfect Further, no study has quantitatively assessed the factors influencing ART adherence In order to reduce these gaps, this study was designed to include several phases and used a multi-method approach to examine levels of ART non-adherence and its relationship to a range of demographic, clinical, social and psychological factors The study began with an exploratory qualitative phase employing four focus group discussions and 30 in-depth interviews with PLHIV, peer educators, carers and health care providers (HCPs) Survey interviews were completed with 615 PLHIV in five rural and urban out-patient clinics in northern Vietnam using an Audio Computer Assisted Self-Interview (ACASI) and clinical records extraction The survey instrument was carefully developed through a systematic procedure to ensure its reliability and validity Cultural appropriateness was considered in the design and implementation of both the qualitative study and the cross sectional survey The qualitative study uncovered several contrary perceptions between health care providers and HIV/AIDS patients regarding the true levels of ART adherence Health care providers often stated that most of their patients closely adhered to their regimens, while PLHIV and their peers reported that “it is not easy” to so The quantitative survey findings supported the PLHIV and their peers’ point of view in the qualitative study, because non-adherence to ART was relatively common among the study sample Using the ACASI technique, the estimated prevalence of onemonth non-adherence measured by the Visual Analogue Scale (VAS) was iii 24.9% and the prevalence of four-day not-on-time-adherence using the modified Adult AIDS Clinical Trials Group (AACTG) instrument was 29% Observed agreement between the two measures was 84% and kappa coefficient was 0.60 (SE=0.04 and p-YTCC by the Dean of Hanoi School of Public Health on the Issuing Regulation of the Insitutional Ethical Review Board of Hanoi School of Public Health; 24 September 2004; After reviewing research ethics application No 08-060/DD-YTCC; And based on the memo dated October 16, 2008 DECIDED Article Grant ethical approval for clinical study: Study Title: Antiretr ovir·al therapy (ARV) adher en ce a mong p eople living with JIIV/AIDS (PLWRA) in the Nor th of Vietna m : a mu lti-method a p proach Principa l Investigator: Do Mai Hoa, MD, MPH The Hanoi School of Public Health, Vietnam Research sites: HaNoi and Hai Duong, Vietnam Data collection time: from I 0/2008 to 03/2009 Project Time: from 10/2008 to 02/2010 Article This decision is effective from 10/20/2008 to 02/2010 Article Principle Investigator should notify the Institutional Ethical Review Board of Hanoi School of Public Health (JRB of HSPH) immediately of any adverse effects ansmg from this study (e.g unexpected adverse outcomes, unexpected community/subject risk factors or complaints, etc.) Active research projects are subject to random audit by the IR.B of HSPH CHAIR OF INSTITUTIONAL ETIDCAL REVIEW BOARD (Signature and full name) Nguyen T ba nh Hu ong SECRETARY (Signature and full name) ﾷｾ Le T hi Ki m Anh 240 Appendix I NVivo Software Tree Node 241 242 Appendix K 243 Appendix K PICTURES OF ACASI INSTRUMENTS, STUDY SITES, AND DATA COLLECTION Picture K1: A set of ACASI equipment: computer, mouse and headphone Picture K2: A respondent completed the questionnaire by ACASI technique 244 Picture K3: Hai Duong Out-Patient Clinic Picture K4: Dong Da Out-Patient Clinic 245 Picture K5: Guiding Respondent to Answer Questions via ACASI Technique Picture K6: Clinical Record Extraction 246 ...KEYWORDS HIV/ AIDS Antiretroviral Therapy Antiretroviral Therapy adherence Antiretroviral People Living with HIV/ AIDS HIV/ AIDS patient Multi- method/ mixed method Audio Computer-Assisted Self-Interview... Michael Dunne, Masaya Kato, Kinh Nguyen Antiretroviral Therapy Adherence among People Living with HIV/ AIDS in the North of Vietnam: A qualitative study (The 4th International Conference on HIV. .. Viet Nam Level Prevalence Factors Correlates i ii ABSTRACT The antiretroviral therapy (ART) program for People Living with HIV/ AIDS (PLHIV) in Vietnam has been scaled up rapidly in recent years