# name
Health care provider communication training in rural Tanzania
                empowers HIV-infected patients on antiretroviral therapy to
                discuss adherence problems

# metadata.dc.contributor.author[].value
Kilombero Ulanga Antiretroviral Cohort (KIULARCO) study group

# metadata.dc.description.abstract[].value
Objectives: Self-reported adherence assessment in HIV-infected patients on antiretroviral therapy (ART) is
challenging and may overestimate adherence. The aim of this study was to improve the ability of
health care providers to elicit patients’ reports of nonadherence using a “patient-centred” approach
in a rural sub-Saharan African setting. Methods: A prospective interventional cohort study of HIV-infected patients on ART for ≥ 6 months attending an
HIV clinic in rural Tanzania was carried out. The intervention consisted of a 2-day workshop for health
care providers on patient-centred communication and the provision of an adherence assessment checklist
for use in the consultations. Patients’ self-reports of nonadherence (≥ 1 missed ART dose/4 weeks),
subtherapeutic plasma ART concentrations (< 2.5th percentile of published population-based
pharmacokinetic models), and virological and immunological failure according to the World Health
Organization definition were assessed before and after (1–3 and 6–9 months after) the intervention. Results: Before the intervention, only 3.3% of 299 patients included in the study reported nonadherence.
Subtherapeutic plasma ART drug concentrations and virological and immunological failure were
recorded in 6.5%, 7.7% and 14.5% of the patients, respectively. Two months after the intervention,
health care providers detected significantly more patients reporting nonadherence compared with
baseline (10.7 vs. 3.3%, respectively; P < 0.001), decreasing to 5.7% after 6–9 months. A time
trend towards higher drug concentrations was observed for efavirenz but not for other drugs. The
virological failure rate remained unchanged whereas the immunological failure rate decreased from
14.4 to 8.7% at the last visit (P = 0.002). Conclusions: 
Patient-centred communication can successfully be implemented with a simple intervention in
rural Africa. It increases the likelihood of HIV-infected patients reporting problems with adherence
to ART; however, sustainability remains a challenge.

# metadata.dc.relation.ispartof[].value
HIV Medicine, 2017, vol. , num. , p. Ahead of print

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Health care provider communication training in rural Tanzania
                empowers HIV-infected patients on antiretroviral therapy to
                discuss adherence problems