Risk factors for poor virological outcome at 12 months in a workplace-based antiretroviral therapy programme in South Africa: A cohort study

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dc.contributor.authorFielding, Katherineen_ZA
dc.contributor.authorCharalambous, Salomeen_ZA
dc.contributor.authorStenson, Amyen_ZA
dc.contributor.authorPemba, Lindiween_ZA
dc.contributor.authorMartin, Desen_ZA
dc.contributor.authorWood, Robinen_ZA
dc.contributor.authorChurchyard, Gavinen_ZA
dc.contributor.authorGrant, Alisonen_ZA
dc.date.accessioned2015-10-28T06:50:54Z
dc.date.available2015-10-28T06:50:54Z
dc.date.issued2008en_ZA
dc.description.abstractBACKGROUND: Reasons for the variation in reported treatment outcomes from antiretroviral therapy (ART) programmes in developing countries are not clearly defined. METHODS: Among ART-naive individuals in a workplace ART programme in South Africa we determined virological outcomes at 12 months, and risk factors for suboptimal virological outcome, defined as plasma HIV-1 viral load >= 400 copies/ml. RESULTS: Among 1760 individuals starting ART before July 2004, 1172 were in follow-up at 12 months of whom 953 (81%) had a viral load measurement (median age 41 yrs, 96% male, median baseline CD4 count 156 x 106/l). 71% (681/953) had viral load < 400 copies/ml at 12 months. In a multivariable analysis, independent predictors of suboptimal virological outcome at 12 months were <1 log decrease in viral load at six weeks (odds ratio [OR] 4.71, 95% confidence interval [CI] 2.56-8.68), viral load at baseline (OR 3.63 [95% CI 1.88-7.00] and OR 3.54 [95% CI 1.79-7.00] for 10,001-100,000 and >100,000 compared to <= 10,000 copies/ml, respectively), adherence at six weeks (OR 3.50 [95% CI 1.92-6.35]), WHO stage (OR 2.08 [95% CI 1.28-3.34] and OR 2.03 [95% CI 1.14-3.62] for stage 3 and 4 compared to stage 1-2, respectively) and site of ART delivery. Site of delivery remained an independent risk factor even after adjustment for individual level factors. At 6 weeks, of 719 patients with self-reported adherence and viral load, 72 (10%) reported 100% adherence but had <1 log decrease in viral load; conversely, 60 (8%) reported <100% adherence but had >= 1 log decrease in viral load. CONCLUSION: Virological response at six weeks after ART start was the strongest predictor of suboptimal virological outcome at 12 months, and may identify individuals who need interventions such as additional adherence support. Self reported adherence was less strongly associated but identified different patients compared with viral load at 6 weeks. Site of delivery had an important influence on virological outcomes; factors at the health system level which influence outcome need further investigation to guide development of effective ART programmes.en_ZA
dc.identifier.apacitationFielding, K., Charalambous, S., Stenson, A., Pemba, L., Martin, D., Wood, R., ... Grant, A. (2008). Risk factors for poor virological outcome at 12 months in a workplace-based antiretroviral therapy programme in South Africa: A cohort study. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/14429en_ZA
dc.identifier.chicagocitationFielding, Katherine, Salome Charalambous, Amy Stenson, Lindiwe Pemba, Des Martin, Robin Wood, Gavin Churchyard, and Alison Grant "Risk factors for poor virological outcome at 12 months in a workplace-based antiretroviral therapy programme in South Africa: A cohort study." <i>BMC Infectious Diseases</i> (2008) http://hdl.handle.net/11427/14429en_ZA
dc.identifier.citationFielding, K. L., Charalambous, S., Stenson, A. L., Pemba, L. F., Martin, D. J., Wood, R., ... & Grant, A. D. (2008). Risk factors for poor virological outcome at 12 months in a workplace-based antiretroviral therapy programme in South Africa: a cohort study. BMC infectious diseases, 8(1), 93.en_ZA
dc.identifier.ris TY - Journal Article AU - Fielding, Katherine AU - Charalambous, Salome AU - Stenson, Amy AU - Pemba, Lindiwe AU - Martin, Des AU - Wood, Robin AU - Churchyard, Gavin AU - Grant, Alison AB - BACKGROUND: Reasons for the variation in reported treatment outcomes from antiretroviral therapy (ART) programmes in developing countries are not clearly defined. METHODS: Among ART-naive individuals in a workplace ART programme in South Africa we determined virological outcomes at 12 months, and risk factors for suboptimal virological outcome, defined as plasma HIV-1 viral load >= 400 copies/ml. RESULTS: Among 1760 individuals starting ART before July 2004, 1172 were in follow-up at 12 months of whom 953 (81%) had a viral load measurement (median age 41 yrs, 96% male, median baseline CD4 count 156 x 106/l). 71% (681/953) had viral load < 400 copies/ml at 12 months. In a multivariable analysis, independent predictors of suboptimal virological outcome at 12 months were <1 log decrease in viral load at six weeks (odds ratio [OR] 4.71, 95% confidence interval [CI] 2.56-8.68), viral load at baseline (OR 3.63 [95% CI 1.88-7.00] and OR 3.54 [95% CI 1.79-7.00] for 10,001-100,000 and >100,000 compared to <= 10,000 copies/ml, respectively), adherence at six weeks (OR 3.50 [95% CI 1.92-6.35]), WHO stage (OR 2.08 [95% CI 1.28-3.34] and OR 2.03 [95% CI 1.14-3.62] for stage 3 and 4 compared to stage 1-2, respectively) and site of ART delivery. Site of delivery remained an independent risk factor even after adjustment for individual level factors. At 6 weeks, of 719 patients with self-reported adherence and viral load, 72 (10%) reported 100% adherence but had <1 log decrease in viral load; conversely, 60 (8%) reported <100% adherence but had >= 1 log decrease in viral load. CONCLUSION: Virological response at six weeks after ART start was the strongest predictor of suboptimal virological outcome at 12 months, and may identify individuals who need interventions such as additional adherence support. Self reported adherence was less strongly associated but identified different patients compared with viral load at 6 weeks. Site of delivery had an important influence on virological outcomes; factors at the health system level which influence outcome need further investigation to guide development of effective ART programmes. DA - 2008 DB - OpenUCT DO - 10.1186/1471-2334-8-93 DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2008 T1 - Risk factors for poor virological outcome at 12 months in a workplace-based antiretroviral therapy programme in South Africa: A cohort study TI - Risk factors for poor virological outcome at 12 months in a workplace-based antiretroviral therapy programme in South Africa: A cohort study UR - http://hdl.handle.net/11427/14429 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14429
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2334-8-93
dc.identifier.vancouvercitationFielding K, Charalambous S, Stenson A, Pemba L, Martin D, Wood R, et al. Risk factors for poor virological outcome at 12 months in a workplace-based antiretroviral therapy programme in South Africa: A cohort study. BMC Infectious Diseases. 2008; http://hdl.handle.net/11427/14429.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDesmond Tutu HIV Centreen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2008 Fielding et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Infectious Diseasesen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcinfectdis/en_ZA
dc.subject.otherAntiretroviral treatment outcomesen_ZA
dc.titleRisk factors for poor virological outcome at 12 months in a workplace-based antiretroviral therapy programme in South Africa: A cohort studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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