Short term adherence tool predicts failure on second line protease inhibitor-based antiretroviral therapy: an observational cohort study

 

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dc.contributor.author Court, Richard
dc.contributor.author Leisegang, Rory
dc.contributor.author Stewart, Annemie
dc.contributor.author Sunpath, Henry
dc.contributor.author Murphy, Richard
dc.contributor.author Winternheimer, Philip
dc.contributor.author Ally, Mashuda
dc.contributor.author Maartens, Gary
dc.date.accessioned 2015-01-19T09:01:33Z
dc.date.available 2015-01-19T09:01:33Z
dc.date.issued 2014-12-04
dc.identifier.citation Court et al.: Short term adherence tool predicts failure on second line protease inhibitor-based antiretroviral therapy: an observational cohort study. BMC Infectious Diseases 2014 14:664. en_ZA
dc.identifier.issn 1471-2334 en_ZA
dc.identifier.uri http://dx.doi.org/10.1186/s12879-014-0664-3
dc.identifier.uri http://hdl.handle.net/11427/12262
dc.description.abstract Background: Most patients who experience virologic failure (VF) on second line antiretroviral therapy (ART) in low-middle income countries fail due to poor adherence rather than antiretroviral resistance. A simple adherence tool designed to detect VF would conserve resources by rationally limiting need for viral load (VL) testing and, in those countries with access to third line ART, the need for resistance testing. Methods: We conducted an observational cohort study of patients who initiated second line ART at a clinic in Kwazulu-Natal, South Africa. Using clinical and pharmacy refill data extracted from the clinic’s electronic database, we determined risk factors for VF. Three different methods of calculating short term pharmacy refill adherence were evaluated and compared with long term adherence since second line initiation. We also explored the ability of differing durations of short term pharmacy refill to predict VF on second line ART. Results: We included 274 patients with a median follow up of 27 months on second line ART. VF ranged between 3% and 16% within each six month interval after initiating second line ART. 243 patients with at least one VL after 4 months on second line were analysed in the statistical analysis. Pharmacy refill adherence assessed over shorter periods (4 to 6 months) predicted virologic suppression as well as pharmacy refill assessed over longer periods. The risk of VF fell 73% with each 10% increase in adherence measured from pharmacy refills over a 4 month period. Low CD4 count at second line ART initiation was a significant independent risk factor for VF. Conclusion: Patients identified as poorly adherent by short term pharmacy refill are at risk for VF on second line ART. This pragmatic adherence tool could assist in identifying patients who require adherence interventions, and help rationalize use of VL monitoring and resistance testing among patients on second line ART. en_ZA
dc.language eng en_ZA
dc.publisher BioMed Central en_ZA
dc.rights Creative Commons Attribution 4.0 International (CC BY 4.0) *
dc.rights.uri http://creativecommons.org/licenses/by/4.0/ en_ZA
dc.source BMC Infectious Diseases en_ZA
dc.source.uri http://www.biomedcentral.com/1471-2334
dc.subject.other HIV en_ZA
dc.subject.other Second line antiretroviral therapy en_ZA
dc.subject.other Medication adherence en_ZA
dc.subject.other Virologic failure en_ZA
dc.subject.other Pharmacy refill en_ZA
dc.title Short term adherence tool predicts failure on second line protease inhibitor-based antiretroviral therapy: an observational cohort study en_ZA
dc.type Journal Article en_ZA
dc.date.updated 2015-01-15T17:52:22Z
dc.language.rfc3066 en
dc.rights.holder Court et al.; licensee BioMed Central Ltd.
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Division of Clinical Pharmacology en_ZA
uct.type.filetype
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Court, R., Leisegang, R., Stewart, A., Sunpath, H., Murphy, R., Winternheimer, P., ... Maartens, G. (2014). Short term adherence tool predicts failure on second line protease inhibitor-based antiretroviral therapy: an observational cohort study. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/12262 en_ZA
dc.identifier.chicagocitation Court, Richard, Rory Leisegang, Annemie Stewart, Henry Sunpath, Richard Murphy, Philip Winternheimer, Mashuda Ally, and Gary Maartens "Short term adherence tool predicts failure on second line protease inhibitor-based antiretroviral therapy: an observational cohort study." <i>BMC Infectious Diseases</i> (2014) http://hdl.handle.net/11427/12262 en_ZA
dc.identifier.vancouvercitation Court R, Leisegang R, Stewart A, Sunpath H, Murphy R, Winternheimer P, et al. Short term adherence tool predicts failure on second line protease inhibitor-based antiretroviral therapy: an observational cohort study. BMC Infectious Diseases. 2014; http://hdl.handle.net/11427/12262. en_ZA
dc.identifier.ris TY - Journal Article AU - Court, Richard AU - Leisegang, Rory AU - Stewart, Annemie AU - Sunpath, Henry AU - Murphy, Richard AU - Winternheimer, Philip AU - Ally, Mashuda AU - Maartens, Gary AB - Background: Most patients who experience virologic failure (VF) on second line antiretroviral therapy (ART) in low-middle income countries fail due to poor adherence rather than antiretroviral resistance. A simple adherence tool designed to detect VF would conserve resources by rationally limiting need for viral load (VL) testing and, in those countries with access to third line ART, the need for resistance testing. Methods: We conducted an observational cohort study of patients who initiated second line ART at a clinic in Kwazulu-Natal, South Africa. Using clinical and pharmacy refill data extracted from the clinic’s electronic database, we determined risk factors for VF. Three different methods of calculating short term pharmacy refill adherence were evaluated and compared with long term adherence since second line initiation. We also explored the ability of differing durations of short term pharmacy refill to predict VF on second line ART. Results: We included 274 patients with a median follow up of 27 months on second line ART. VF ranged between 3% and 16% within each six month interval after initiating second line ART. 243 patients with at least one VL after 4 months on second line were analysed in the statistical analysis. Pharmacy refill adherence assessed over shorter periods (4 to 6 months) predicted virologic suppression as well as pharmacy refill assessed over longer periods. The risk of VF fell 73% with each 10% increase in adherence measured from pharmacy refills over a 4 month period. Low CD4 count at second line ART initiation was a significant independent risk factor for VF. Conclusion: Patients identified as poorly adherent by short term pharmacy refill are at risk for VF on second line ART. This pragmatic adherence tool could assist in identifying patients who require adherence interventions, and help rationalize use of VL monitoring and resistance testing among patients on second line ART. DA - 2014-12-04 DB - OpenUCT DO - 10.1186/s12879-014-0664-3 DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 SM - 1471-2334 T1 - Short term adherence tool predicts failure on second line protease inhibitor-based antiretroviral therapy: an observational cohort study TI - Short term adherence tool predicts failure on second line protease inhibitor-based antiretroviral therapy: an observational cohort study UR - http://hdl.handle.net/11427/12262 ER - en_ZA


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