Evaluation of adherence measures of antiretroviral prophylaxis in HIV exposed infants in the first 6 weeks of life

 

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dc.contributor.author Desmond, Alicia C
dc.contributor.author Moodley, Dhayendre
dc.contributor.author Conolly, Catherine A
dc.contributor.author Castel, Sandra A
dc.contributor.author Coovadia, Hoosen M
dc.date.accessioned 2015-07-30T03:58:19Z
dc.date.available 2015-07-30T03:58:19Z
dc.date.issued 2015-03-19
dc.identifier.citation Desmond, A. C., Moodley, D., Conolly, C. A., Castel, S. A., & Coovadia, H. M. (2015). Evaluation of adherence measures of antiretroviral prophylaxis in HIV exposed infants in the first 6 weeks of life. BMC pediatrics, 15(1), 23.
dc.identifier.uri http://hdl.handle.net/11427/13601
dc.identifier.uri http://dx.doi.org/10.1186/s12887-015-0340-9
dc.description.abstract Abstract Background Adherence to an antiretroviral regimen is imperative for treatment success in both HIV infected adults and children. Likewise, adherence to antiretroviral prophylaxis is critical in HIV prevention. Studies on pediatric adherence are limited, particularly the prophylactic use of antiretroviral drugs and treatment adherence in very young infants. The HIV Prevention Trials Network (HPTN) 046 study (Clinical Trial Registration NCT00074412) determined the safety and efficacy of an extended regimen of nevirapine suspension in infants born to HIV-1 infected women for the prevention of vertical HIV transmission during breastfeeding. As per protocol, adherence to nevirapine prophylaxis was measured by maternal verbal reports. In addition, the pharmacy assessed the unused returned suspension. The aim of this sub-study was to determine the reliability of maternal verbal reports in measuring adherence to antiretroviral prophylaxis in infants in the first 6 weeks of life and evaluating the unused returned nevirapine as an alternative method of measuring adherence. Methods Maternal verbal reports and pharmacy returns indicative of “missed < 2 doses” were evaluated against a plasma nevirapine concentration of >100 ng/ml in a subgroup of infants at 2, 5 and 6 weeks of age. Plasma nevirapine concentration of >100 ng/ml was used as a marker of adherence (10 times the in vitro IC50 against HIV). Results Adherence was 87.7% (maternal verbal report) and 71.3% (unused returned medication), as compared to 85.6% by plasma nevirapine concentration. Evaluated against plasma nevirapine concentration <100 ng/ml, the sensitivity and specificity of maternal verbal reports to detect a missed dose in the last 3 days were 75% and 78% (p = 0.03) respectively. Overall, among infants who were classified as adherent based on missed doses by maternal verbal reports and unused returned medication, 88.4% and 87.4% of infants attained a nevirapine concentration above 100 ng/ml respectively. Conclusion Maternal verbal reports are a reliable measure of adherence to infant antiretroviral prophylaxis in the first 6 weeks of life and could be useful in assessing adherence to antiretroviral treatment in infants younger than 6 weeks. In the absence of resources or expertise to determine plasma drug concentration, we would recommend random assessments of unused returned medication.
dc.rights This is an Open Access article distributed under the terms of the Creative Commons Attribution License *
dc.rights.uri http://creativecommons.org/licenses/by/4.0 *
dc.source BMC Pediatrics en_ZA
dc.source.uri http://www.biomedcentral.com/bmcpediatr/
dc.subject.other Adherence measures en_ZA
dc.subject.other Infants en_ZA
dc.subject.other Antiretroviral prophylaxis en_ZA
dc.subject.other Maternal verbal report en_ZA
dc.subject.other Pharmacy returns en_ZA
dc.title Evaluation of adherence measures of antiretroviral prophylaxis in HIV exposed infants in the first 6 weeks of life
dc.type Journal Article en_ZA
dc.date.updated 2015-03-31T18:02:13Z
dc.language.rfc3066 en
dc.rights.holder Desmond et al.; licensee BioMed Central.
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
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This is an Open Access article distributed under the terms of the Creative Commons Attribution License Except where otherwise noted, this item's license is described as This is an Open Access article distributed under the terms of the Creative Commons Attribution License