@article{fdi:010071348,
  title = {{A}dherence to {PI}-based 2nd-line regimens in {C}ambodia is not simply a question of individual behaviour : the {ANRS} 12276 2{PICAM} study},
  author = {{S}agaon {T}eyssier, {L}uis and {M}madi {M}renda, {B}. and {K}hol, {V}. and {F}erradini, {L}. and {M}am, {S}. and {N}gin, {S}. and {M}ora, {M}. and {M}aradan, {G}. and {M}ean, {C}. {V}. and {S}egeral, {O}. and {N}errienet, {E}. and {S}aphonn, {V}. and {S}pire, {B}.},
  editor = {},
  language = {{ENG}},
  abstract = {{O}bjectives{T}o investigate whether adherence to antiretroviral treatment ({ART}) can be explained not only by individual factors but also by health care facilities' characteristics, among a sample of people living with {HIV} ({PLWH}) treated with {PI}-based regimens in {C}ambodia. {M}ethods{T}he {ANRS} 12276 2{PICAM} cross-sectional survey was conducted between {F}ebruary 2013 and {A}pril 2014 among {PLWH} followed up in 13 health care facilities. {T}he 1316 patients in this analysis corresponded to 90% of the total number of adult patients treated with 2nd-line {PI}-based regimens in {C}ambodia in the study period. {A} variable indicating whether patients were non-adherent (=1) or completely adherent (=0) was constructed. {H}ealth care facilities and individual characteristics were included in a two-level logistic model to investigate their influence on patients' adherence to {ART}. {R}esults{A} total of 17% of participants did not adhere to {ART}. {P}atients in health care facilities outside the capital {P}hnom {P}enh were six times more likely to be non-adherent than those treated in health care facilities in the capital ({OR}: 6.15, 95% {CI} [1.47, 25.79]). {P}roviding 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 health care facilities ({OR}: 0.62, 95% {CI} [0.43, 0.89]). {F}inancial constraints were the main individual factor preventing adherence. {C}onclusions{O}ur results suggest that inefficiencies in health care delivery are detrimental to {PLWH} health and to the exceptional progress currently being made by {C}ambodia in response to {HIV}. {P}olicy makers should focus on increasing the number of psychosocial workers, especially in areas outside the capital. {O}bjectifs{I}nvestiguer si l'adhesion au traitement antiretroviral ({ART}) peut etre expliquee non seulement par des facteurs individuels mais aussi par les caracteristiques des etablissements de sante, dans un echantillon de personnes vivant avec le {VIH} ({PVVIH}), traitees par des schemas a base d'{IP} au {C}ambodge. {M}ethodes{L}'enquete transversale {ANRS} 12276 2{PICAM} a ete menee entre fevrier 2013 et avril 2014 chez des {PLWH} suivies dans 13 etablissements de sante. {L}es 1316 patients dans cette analyse correspondaient a 90% du nombre total des patients adultes traites par des schemas de 2(e) ligne a base d'{IP} au {C}ambodge durant la periode d'etude. {U}ne variable indiquant si les patients etaient non adherents (= 1) ou totalement adherents (= 0) a ete construite. {L}es caracteristiques des etablissements de soins de sante et individuels ont ete incluses dans un modele logistique a deux niveaux afin d'etudier leur influence sur l'adhesion des patients a l'{ART}. {R}esultats17% des participants n'on pas adhere a l'{ART}. {L}es patients dans les etablissements de soins de sante en dehors de la capitale {P}hnom {P}enh etaient six fois plus susceptibles d'etre non-adherents que ceux traites dans les etablissements de sante dans la capitale ({OR}: 6,15; {IC}95%: 1,47-25,79). {L}a fourniture de soins psychosociaux (par des psychologues et/ou des coaches a temps plein) a ete trouve comme etant un facilitateur structurel de l'adhesion, vu que la probabilite de non-adhesion a chute de 38,5% par chaque agent psychologique supplementaire present dans les etablissements de sante ({OR}: 0,62; {IC}95%: 0,43-0,89). {L}es contraintes financieres etaient le principal facteur individuel empechant l'adhesion. {C}onclusions{N}os resultats suggerent que l'inefficacite dans la prestation des soins de sante est prejudiciable a la sante des {PLWH} et aux progres exceptionnels realises actuellement par le {C}ambodge en reponse au {VIH}. {L}es decideurs devraient se concentrer sur l'augmentation du nombre des agents psychosociaux, en particulier dans les zones situees a l'exterieur de la capitale.},
  keywords = {adherence ; {PI} regimen ; {C}ambodia ; multilevel modelling ; adhesion ; schema ; a base d'{IP} ; {C}ambodge ; modelisation multi-niveaux ; {CAMBODGE}},
  booktitle = {},
  journal = {{T}ropical {M}edicine and {I}nternational {H}ealth},
  volume = {22},
  numero = {11},
  pages = {1428--1435},
  ISSN = {1360-2276},
  year = {2017},
  DOI = {10.1111/tmi.12975},
  URL = {https://www.documentation.ird.fr/hor/fdi:010071348},
}