Using electronic methods of adherence monitoring and therapeutic drug monitoring (TDM) to eliminate discordance between antiretroviral adherence and virological failure

 

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dc.contributor.advisor Wood, Robin en_ZA
dc.contributor.advisor Maartens, Gary en_ZA
dc.contributor.author Orrell, Catherine en_ZA
dc.date.accessioned 2016-07-14T12:22:26Z
dc.date.available 2016-07-14T12:22:26Z
dc.date.issued 2016 en_ZA
dc.identifier.citation Orrell, C. 2016. Using electronic methods of adherence monitoring and therapeutic drug monitoring (TDM) to eliminate discordance between antiretroviral adherence and virological failure. University of Cape Town. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/20349
dc.description.abstract Background: Adherence to antiretroviral therapy (ART) is critical: only 70% achieve viral suppression at a year. Current adherence methodologies, with slow reaction to missed dosing, inadequately predict virological outcomes. Ideal adherence methods would be cheap, easy to use, and allow rapid response to missed doses to improve outcomes. We explored ideal adherence monitoring methodology for a large public sector ART clinic in Cape Town. Methods: We designed a randomised controlled study for ART-naïve individuals to determine whether text messaging after a missed dose would improve adherence recorded by an electronic adherence monitoring device (EAMD), reduce treatment interruptions or impact on virological outcome (using regression modelling). Five other measures of adherence were captured prospectively during the study: selfrecall (SR), clinic-based pill count (CPC), pharmacy refill data (PR-average or PR-gaps) and efavirenz concentration. The predictive value of each adherence methodology on virological and HIV-1 resistance outcomes was compared by calculating the area under the receiver operating characteristic curve, from logistic regression models. The impact of efavirenz concentration and CYP2B6 metaboliser genotype data on failure was examined using Cox proportion hazard modelling; and the most predictive lower limit for EFV concentration was determined. Antiretroviral cohort and pharmacy refill data were compared, using simple statistics, to determine which provided the best method of determining those retained in care. en_ZA
dc.language.iso eng en_ZA
dc.subject.other Infectious Disease and Molecular Medicine en_ZA
dc.subject.other Monitoring en_ZA
dc.title Using electronic methods of adherence monitoring and therapeutic drug monitoring (TDM) to eliminate discordance between antiretroviral adherence and virological failure en_ZA
dc.type Doctoral Thesis
uct.type.publication Research en_ZA
uct.type.resource Thesis en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Department of Medicine en_ZA
dc.type.qualificationlevel Doctoral
dc.type.qualificationname PhD en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Orrell, C. (2016). <i>Using electronic methods of adherence monitoring and therapeutic drug monitoring (TDM) to eliminate discordance between antiretroviral adherence and virological failure</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Medicine. Retrieved from http://hdl.handle.net/11427/20349 en_ZA
dc.identifier.chicagocitation Orrell, Catherine. <i>"Using electronic methods of adherence monitoring and therapeutic drug monitoring (TDM) to eliminate discordance between antiretroviral adherence and virological failure."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2016. http://hdl.handle.net/11427/20349 en_ZA
dc.identifier.vancouvercitation Orrell C. Using electronic methods of adherence monitoring and therapeutic drug monitoring (TDM) to eliminate discordance between antiretroviral adherence and virological failure. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2016 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/20349 en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Orrell, Catherine AB - Background: Adherence to antiretroviral therapy (ART) is critical: only 70% achieve viral suppression at a year. Current adherence methodologies, with slow reaction to missed dosing, inadequately predict virological outcomes. Ideal adherence methods would be cheap, easy to use, and allow rapid response to missed doses to improve outcomes. We explored ideal adherence monitoring methodology for a large public sector ART clinic in Cape Town. Methods: We designed a randomised controlled study for ART-naïve individuals to determine whether text messaging after a missed dose would improve adherence recorded by an electronic adherence monitoring device (EAMD), reduce treatment interruptions or impact on virological outcome (using regression modelling). Five other measures of adherence were captured prospectively during the study: selfrecall (SR), clinic-based pill count (CPC), pharmacy refill data (PR-average or PR-gaps) and efavirenz concentration. The predictive value of each adherence methodology on virological and HIV-1 resistance outcomes was compared by calculating the area under the receiver operating characteristic curve, from logistic regression models. The impact of efavirenz concentration and CYP2B6 metaboliser genotype data on failure was examined using Cox proportion hazard modelling; and the most predictive lower limit for EFV concentration was determined. Antiretroviral cohort and pharmacy refill data were compared, using simple statistics, to determine which provided the best method of determining those retained in care. DA - 2016 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - Using electronic methods of adherence monitoring and therapeutic drug monitoring (TDM) to eliminate discordance between antiretroviral adherence and virological failure TI - Using electronic methods of adherence monitoring and therapeutic drug monitoring (TDM) to eliminate discordance between antiretroviral adherence and virological failure UR - http://hdl.handle.net/11427/20349 ER - en_ZA


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