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

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dc.contributor.authorCourt, Richard
dc.contributor.authorLeisegang, Rory
dc.contributor.authorStewart, Annemie
dc.contributor.authorSunpath, Henry
dc.contributor.authorMurphy, Richard
dc.contributor.authorWinternheimer, Philip
dc.contributor.authorAlly, Mashuda
dc.contributor.authorMaartens, Gary
dc.date.accessioned2015-01-19T09:01:33Z
dc.date.available2015-01-19T09:01:33Z
dc.date.issued2014-12-04
dc.date.updated2015-01-15T17:52:22Z
dc.description.abstractBackground: 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.identifier.apacitationCourt, 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/11427/12262en_ZA
dc.identifier.chicagocitationCourt, 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/11427/12262en_ZA
dc.identifier.citationCourt 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.issn1471-2334en_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
dc.identifier.urihttp://dx.doi.org/10.1186/s12879-014-0664-3
dc.identifier.urihttp://hdl.handle.net/11427/12262
dc.identifier.vancouvercitationCourt 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.languageengen_ZA
dc.language.rfc3066en
dc.publisherBioMed Centralen_ZA
dc.publisher.departmentDivision of Clinical Pharmacologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsCreative Commons Attribution 4.0 International (CC BY 4.0)*
dc.rights.holderCourt et al.; licensee BioMed Central Ltd.
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_ZA
dc.sourceBMC Infectious Diseasesen_ZA
dc.source.urihttp://www.biomedcentral.com/1471-2334
dc.subject.otherHIVen_ZA
dc.subject.otherSecond line antiretroviral therapyen_ZA
dc.subject.otherMedication adherenceen_ZA
dc.subject.otherVirologic failureen_ZA
dc.subject.otherPharmacy refillen_ZA
dc.titleShort term adherence tool predicts failure on second line protease inhibitor-based antiretroviral therapy: an observational cohort studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetype
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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