Adherence to first-line antiretroviral therapy affects non-virologic outcomes among patients on treatment for more than 12 months in Lusaka, Zambia
Identifieur interne : 005B24 ( Main/Exploration ); précédent : 005B23; suivant : 005B25Adherence to first-line antiretroviral therapy affects non-virologic outcomes among patients on treatment for more than 12 months in Lusaka, Zambia
Auteurs : Benjamin H. Chi [Zambie, États-Unis] ; Ronald A. Cantrell [Zambie, États-Unis] ; Isaac Zulu [Zambie] ; Lloyd B. Mulenga [Zambie] ; Jens W. Levy [Zambie, États-Unis] ; Bushimbwa C. Tambatamba [Zambie] ; Stewart Reid [Zambie, États-Unis] ; Albert Mwango [Zambie] ; Alwyn Mwinga [Zambie] ; Marc Bulterys [Zambie] ; Michael S. Saag [États-Unis] ; Jeffrey Sa Stringer [Zambie, États-Unis]Source :
- International journal of epidemiology [ 0300-5771 ] ; 2009.
Descripteurs français
- Pascal (Inist)
- Wicri :
- geographic : Zambie.
- topic : Homme, Médicament, Mortalité, Santé publique.
English descriptors
- KwdEn :
Abstract
Background High-level adherence to antiretroviral therapy (ART) is associated with favourable patient outcomes. In resource-constrained settings, however, there are few validated measures. We examined the correlation between clinical outcomes and the medication possession ratio (MPR), a pharmacy-based measure of adherence. Methods We analysed data from a large programmatic cohort across 18 primary care centres providing ART in Lusaka, Zambia. Patients were stratified into three categories based on MPR-calculated adherence over the first 12 months: optimal (≥95%), suboptimal (80-94%) and poor (<80%). Results Overall, 27115 treatment-naïve adults initiated and continued ART for ≥12 months: 17 060 (62.9%) demonstrated optimal adherence, 7682 (28.3%) had suboptimal adherence and 2373 (8.8%) had poor adherence. When compared with those with optimal adherence, post-12-month mortality risk was similar among patients with sub-optimal adherence [adjusted hazard ratio (AHR)=1.0; 95% CI: 0.9-1.2] but higher in patients with poor adherence (AHR=1.7; 95% CI: 1.4-2.2). Those <80% MPR also appeared to have an attenuated CD4 response at 18 months (185 cells/μl vs 217 cells/μl; P<0.001), 24 months (213 cells/μl vs 246 cells/μl; P<0.001), 30 months (226 cells/μl vs 261 cells/μl; P < 0.001) and 36 months (245 cells/μl vs 275 cells/μl; P<0.01) when compared with those above this threshold. Conclusions MPR was predictive of clinical outcomes and immunologic response in this large public sector antiretroviral treatment program. This marker may have a role in guiding programmatic monitoring and clinical care in resource-constrained settings.
Affiliations:
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Adherence to first-line antiretroviral therapy affects non-virologic outcomes among patients on treatment for more than 12 months in Lusaka, Zambia</title>
<author><name sortKey="Chi, Benjamin H" sort="Chi, Benjamin H" uniqKey="Chi B" first="Benjamin H." last="Chi">Benjamin H. Chi</name>
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<affiliation wicri:level="1"><inist:fA14 i1="03"><s1>US Centers for Disease Control and Prevention Global AIDS Program</s1>
<s2>Lusaka</s2>
<s3>ZMB</s3>
<sZ>3 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
</inist:fA14>
<country>Zambie</country>
<wicri:noRegion>US Centers for Disease Control and Prevention Global AIDS Program</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Saag, Michael S" sort="Saag, Michael S" uniqKey="Saag M" first="Michael S." last="Saag">Michael S. Saag</name>
<affiliation wicri:level="2"><inist:fA14 i1="02"><s1>School of Medicine and Public Health, University of Alabama</s1>
<s2>Birmingham, AL</s2>
<s3>USA</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>11 aut.</sZ>
<sZ>12 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<placeName><region type="state">Alabama</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Stringer, Jeffrey Sa" sort="Stringer, Jeffrey Sa" uniqKey="Stringer J" first="Jeffrey Sa" last="Stringer">Jeffrey Sa Stringer</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Centre for Infectious Disease Research in Zambia</s1>
<s2>Lusaka</s2>
<s3>ZMB</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>4 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>12 aut.</sZ>
</inist:fA14>
<country>Zambie</country>
<wicri:noRegion>Centre for Infectious Disease Research in Zambia</wicri:noRegion>
</affiliation>
<affiliation wicri:level="2"><inist:fA14 i1="02"><s1>School of Medicine and Public Health, University of Alabama</s1>
<s2>Birmingham, AL</s2>
<s3>USA</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>5 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>11 aut.</sZ>
<sZ>12 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<placeName><region type="state">Alabama</region>
</placeName>
</affiliation>
</author>
</analytic>
<series><title level="j" type="main">International journal of epidemiology</title>
<title level="j" type="abbreviated">Int. j. epidemiol.</title>
<idno type="ISSN">0300-5771</idno>
<imprint><date when="2009">2009</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt><title level="j" type="main">International journal of epidemiology</title>
<title level="j" type="abbreviated">Int. j. epidemiol.</title>
<idno type="ISSN">0300-5771</idno>
</seriesStmt>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term>
<term>Adhesion</term>
<term>Antiretroviral agent</term>
<term>Antiviral</term>
<term>Chemotherapy</term>
<term>Drug</term>
<term>Epidemiology</term>
<term>Evolution</term>
<term>Human</term>
<term>Human immunodeficiency virus</term>
<term>Mortality</term>
<term>Patient</term>
<term>Prognosis</term>
<term>Public health</term>
<term>Survival</term>
<term>Treatment</term>
<term>Treatment compliance</term>
<term>Zambia</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>SIDA</term>
<term>Observance thérapeutique</term>
<term>Antiviral</term>
<term>Antirétroviral</term>
<term>Pronostic</term>
<term>Evolution</term>
<term>Homme</term>
<term>Malade</term>
<term>Traitement</term>
<term>Zambie</term>
<term>Virus immunodéficience humaine</term>
<term>Adhérence</term>
<term>Médicament</term>
<term>Chimiothérapie</term>
<term>Mortalité</term>
<term>Epidémiologie</term>
<term>Survie</term>
<term>Santé publique</term>
</keywords>
<keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Zambie</term>
</keywords>
<keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term>
<term>Médicament</term>
<term>Mortalité</term>
<term>Santé publique</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en">Background High-level adherence to antiretroviral therapy (ART) is associated with favourable patient outcomes. In resource-constrained settings, however, there are few validated measures. We examined the correlation between clinical outcomes and the medication possession ratio (MPR), a pharmacy-based measure of adherence. Methods We analysed data from a large programmatic cohort across 18 primary care centres providing ART in Lusaka, Zambia. Patients were stratified into three categories based on MPR-calculated adherence over the first 12 months: optimal (≥95%), suboptimal (80-94%) and poor (<80%). Results Overall, 27115 treatment-naïve adults initiated and continued ART for ≥12 months: 17 060 (62.9%) demonstrated optimal adherence, 7682 (28.3%) had suboptimal adherence and 2373 (8.8%) had poor adherence. When compared with those with optimal adherence, post-12-month mortality risk was similar among patients with sub-optimal adherence [adjusted hazard ratio (AHR)=1.0; 95% CI: 0.9-1.2] but higher in patients with poor adherence (AHR=1.7; 95% CI: 1.4-2.2). Those <80% MPR also appeared to have an attenuated CD4 response at 18 months (185 cells/μl vs 217 cells/μl; P<0.001), 24 months (213 cells/μl vs 246 cells/μl; P<0.001), 30 months (226 cells/μl vs 261 cells/μl; P < 0.001) and 36 months (245 cells/μl vs 275 cells/μl; P<0.01) when compared with those above this threshold. Conclusions MPR was predictive of clinical outcomes and immunologic response in this large public sector antiretroviral treatment program. This marker may have a role in guiding programmatic monitoring and clinical care in resource-constrained settings.</div>
</front>
</TEI>
<affiliations><list><country><li>Zambie</li>
<li>États-Unis</li>
</country>
<region><li>Alabama</li>
</region>
</list>
<tree><country name="Zambie"><noRegion><name sortKey="Chi, Benjamin H" sort="Chi, Benjamin H" uniqKey="Chi B" first="Benjamin H." last="Chi">Benjamin H. Chi</name>
</noRegion>
<name sortKey="Bulterys, Marc" sort="Bulterys, Marc" uniqKey="Bulterys M" first="Marc" last="Bulterys">Marc Bulterys</name>
<name sortKey="Cantrell, Ronald A" sort="Cantrell, Ronald A" uniqKey="Cantrell R" first="Ronald A." last="Cantrell">Ronald A. Cantrell</name>
<name sortKey="Levy, Jens W" sort="Levy, Jens W" uniqKey="Levy J" first="Jens W." last="Levy">Jens W. Levy</name>
<name sortKey="Mulenga, Lloyd B" sort="Mulenga, Lloyd B" uniqKey="Mulenga L" first="Lloyd B." last="Mulenga">Lloyd B. Mulenga</name>
<name sortKey="Mwango, Albert" sort="Mwango, Albert" uniqKey="Mwango A" first="Albert" last="Mwango">Albert Mwango</name>
<name sortKey="Mwinga, Alwyn" sort="Mwinga, Alwyn" uniqKey="Mwinga A" first="Alwyn" last="Mwinga">Alwyn Mwinga</name>
<name sortKey="Reid, Stewart" sort="Reid, Stewart" uniqKey="Reid S" first="Stewart" last="Reid">Stewart Reid</name>
<name sortKey="Stringer, Jeffrey Sa" sort="Stringer, Jeffrey Sa" uniqKey="Stringer J" first="Jeffrey Sa" last="Stringer">Jeffrey Sa Stringer</name>
<name sortKey="Tambatamba, Bushimbwa C" sort="Tambatamba, Bushimbwa C" uniqKey="Tambatamba B" first="Bushimbwa C." last="Tambatamba">Bushimbwa C. Tambatamba</name>
<name sortKey="Zulu, Isaac" sort="Zulu, Isaac" uniqKey="Zulu I" first="Isaac" last="Zulu">Isaac Zulu</name>
<name sortKey="Zulu, Isaac" sort="Zulu, Isaac" uniqKey="Zulu I" first="Isaac" last="Zulu">Isaac Zulu</name>
</country>
<country name="États-Unis"><region name="Alabama"><name sortKey="Chi, Benjamin H" sort="Chi, Benjamin H" uniqKey="Chi B" first="Benjamin H." last="Chi">Benjamin H. Chi</name>
</region>
<name sortKey="Cantrell, Ronald A" sort="Cantrell, Ronald A" uniqKey="Cantrell R" first="Ronald A." last="Cantrell">Ronald A. Cantrell</name>
<name sortKey="Levy, Jens W" sort="Levy, Jens W" uniqKey="Levy J" first="Jens W." last="Levy">Jens W. Levy</name>
<name sortKey="Reid, Stewart" sort="Reid, Stewart" uniqKey="Reid S" first="Stewart" last="Reid">Stewart Reid</name>
<name sortKey="Saag, Michael S" sort="Saag, Michael S" uniqKey="Saag M" first="Michael S." last="Saag">Michael S. Saag</name>
<name sortKey="Stringer, Jeffrey Sa" sort="Stringer, Jeffrey Sa" uniqKey="Stringer J" first="Jeffrey Sa" last="Stringer">Jeffrey Sa Stringer</name>
</country>
</tree>
</affiliations>
</record>
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