Evaluation of antiretroviral therapy (ART) provision in an early cohort of patients initiating ART in Ghana
Identifieur interne : 000609 ( Main/Exploration ); précédent : 000608; suivant : 000610Evaluation of antiretroviral therapy (ART) provision in an early cohort of patients initiating ART in Ghana
Auteurs : Sally-Ann Ohene [Ghana] ; Nii Akwei Addo [Ghana] ; Francisca Zigah [Ghana] ; Morkor Newman [Zimbabwe] ; Margaret Lartey [Ghana] ; Maite Alfonso Romero [Ghana] ; Sampson Ofori [Ghana] ; Tania Sheriff [Ghana] ; Tom Ndanu [Ghana]Source :
- The Pan African Medical Journal [ 1937-8688 ] ; 2013.
Descripteurs français
- KwdFr :
- Accessibilité des services de santé (), Accessibilité des services de santé (économie), Adulte, Adulte d'âge moyen, Agents antiVIH (usage thérapeutique), Agents antiVIH (économie), Antirétroviraux (usage thérapeutique), Antirétroviraux (économie), Effets secondaires indésirables des médicaments (épidémiologie), Femelle, Ghana (épidémiologie), Humains, Infections à VIH (), Infections à VIH (traitement médicamenteux), Infections à VIH (économie), Infections à VIH (épidémiologie), Mâle, Observance du traitement médicamenteux (), Substitution de médicament (), Types de pratiques des médecins (), VIH-1 (Virus de l'Immunodéficience Humaine de type 1), Études de cohortes, Études transversales.
- MESH :
- traitement médicamenteux : Infections à VIH.
- usage thérapeutique : Agents antiVIH, Antirétroviraux.
- économie : Accessibilité des services de santé, Agents antiVIH, Antirétroviraux, Infections à VIH.
- épidémiologie : Effets secondaires indésirables des médicaments, Ghana, Infections à VIH.
- Accessibilité des services de santé, Adulte, Adulte d'âge moyen, Femelle, Humains, Infections à VIH, Mâle, Observance du traitement médicamenteux, Substitution de médicament, Types de pratiques des médecins, VIH-1 (Virus de l'Immunodéficience Humaine de type 1), Études de cohortes, Études transversales.
- Wicri :
- geographic : Ghana.
English descriptors
- KwdEn :
- Adult, Anti-HIV Agents (economics), Anti-HIV Agents (therapeutic use), Anti-Retroviral Agents (economics), Anti-Retroviral Agents (therapeutic use), Cohort Studies, Cross-Sectional Studies, Drug Substitution (statistics & numerical data), Drug-Related Side Effects and Adverse Reactions (epidemiology), Female, Ghana (epidemiology), HIV Infections (complications), HIV Infections (drug therapy), HIV Infections (economics), HIV Infections (epidemiology), HIV-1, Health Services Accessibility (economics), Health Services Accessibility (statistics & numerical data), Humans, Male, Medication Adherence (statistics & numerical data), Middle Aged, Practice Patterns, Physicians' (statistics & numerical data).
- MESH :
- chemical , economics : Anti-HIV Agents, Anti-Retroviral Agents.
- chemical , therapeutic use : Anti-HIV Agents, Anti-Retroviral Agents.
- geographic , epidemiology : Ghana.
- complications : HIV Infections.
- drug therapy : HIV Infections.
- economics : HIV Infections, Health Services Accessibility.
- epidemiology : Drug-Related Side Effects and Adverse Reactions, HIV Infections.
- statistics & numerical data : Drug Substitution, Health Services Accessibility, Medication Adherence, Practice Patterns, Physicians'.
- Adult, Cohort Studies, Cross-Sectional Studies, Female, HIV-1, Humans, Male, Middle Aged.
Abstract
Against the background of Ghana's ART program which scaled up rapidly since inception in 2003, the study assessed outcomes of an early cohort of patients initiating ART.
The study utilized the following methods: a cross-sectional study involving patient interviews using a structured questionnaire, a review of records and a retrospective cohort analysis of adults initiating ART between 2003 and 2008 from four selected clinics.
The 683 study participants consisted of 464 females (67.9%) and the mean age was 41 years. Mean duration of treatment was 25 months (SD =13). More than 95% were on a regimen as per national guidelines. Ninety-five (14.1%) of the respondents had one or two drugs substituted. Seventy-three% of the substitutions were due to adverse drug reactions. On at least one occasion, over half (350) had defaulted on a clinic appointment. In the 3 months preceding the survey, 21.4% (146) had missed treatment doses. About 49% (334) had challenges meeting financial obligations related to care. The median weight increased by 5.9kg and 8.0kg at 6 and 12 months after initiating ART respectively over the median baseline weight of 54kg, (p-value = 0.001). The median CD4 count increased by 128, 170 and 256 cells/µl respectively at 6, 12 and 24 months from the median baseline of 125 cell/µl, (p-value = 0.035).
This study of Ghanaian PLHIV on ART from four facilities showed encouraging immunological and clinical outcomes. There were however issues of appointment default, sub-optimum adherence to treatment and cost of care barriers needing attention.
Url:
DOI: 10.11604/pamj.2013.16.117.3136
PubMed: 24778754
PubMed Central: 3998899
Affiliations:
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Le document en format XML
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Country Office, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Addo, Nii Akwei" sort="Addo, Nii Akwei" uniqKey="Addo N" first="Nii Akwei" last="Addo">Nii Akwei Addo</name><affiliation wicri:level="3"><nlm:aff id="AF0002">National AIDS/STI Control Programme, Ghana Health Service, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>National AIDS/STI Control Programme, Ghana Health Service, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Zigah, Francisca" sort="Zigah, Francisca" uniqKey="Zigah F" first="Francisca" last="Zigah">Francisca Zigah</name><affiliation wicri:level="3"><nlm:aff id="AF0003">Korle Bu Teaching Hospital, Accra, Ghana</nlm:aff><country 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xml:lang="fr">Ghana</country><wicri:regionArea>Department of Medicine, University of Ghana Medical School, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><placeName><settlement type="city">Accra</settlement><settlement type="town">Legon (Ghana)</settlement><region type="region">Région du Grand Accra</region></placeName><orgName type="university" n="3">Université du Ghana</orgName></affiliation></author><author><name sortKey="Romero, Maite Alfonso" sort="Romero, Maite Alfonso" uniqKey="Romero M" first="Maite Alfonso" last="Romero">Maite Alfonso Romero</name><affiliation wicri:level="1"><nlm:aff id="AF0006">St Dominic's Hospital, Akwatia, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>St Dominic's Hospital, Akwatia</wicri:regionArea><wicri:noRegion>Akwatia</wicri:noRegion></affiliation></author><author><name sortKey="Ofori, Sampson" sort="Ofori, Sampson" uniqKey="Ofori S" first="Sampson" last="Ofori">Sampson Ofori</name><affiliation wicri:level="1"><nlm:aff id="AF0007">Koforidua Regional Hospital, Koforidua, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Koforidua Regional Hospital, Koforidua</wicri:regionArea><wicri:noRegion>Koforidua</wicri:noRegion></affiliation></author><author><name sortKey="Sheriff, Tania" sort="Sheriff, Tania" uniqKey="Sheriff T" first="Tania" last="Sheriff">Tania Sheriff</name><affiliation wicri:level="3"><nlm:aff id="AF0008">Odorna Clinic, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Odorna Clinic, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Ndanu, Tom" sort="Ndanu, Tom" uniqKey="Ndanu T" first="Tom" last="Ndanu">Tom Ndanu</name><affiliation wicri:level="3"><nlm:aff id="AF0009">University of Ghana Dental School, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>University of Ghana Dental School, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author></analytic><series><title level="j">The Pan African Medical Journal</title><idno type="eISSN">1937-8688</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Anti-HIV Agents (economics)</term><term>Anti-HIV Agents (therapeutic use)</term><term>Anti-Retroviral Agents (economics)</term><term>Anti-Retroviral Agents (therapeutic use)</term><term>Cohort Studies</term><term>Cross-Sectional Studies</term><term>Drug Substitution (statistics & numerical data)</term><term>Drug-Related Side Effects and Adverse Reactions (epidemiology)</term><term>Female</term><term>Ghana (epidemiology)</term><term>HIV Infections (complications)</term><term>HIV Infections (drug therapy)</term><term>HIV Infections (economics)</term><term>HIV Infections (epidemiology)</term><term>HIV-1</term><term>Health Services Accessibility (economics)</term><term>Health Services Accessibility (statistics & numerical data)</term><term>Humans</term><term>Male</term><term>Medication Adherence (statistics & numerical data)</term><term>Middle Aged</term><term>Practice Patterns, Physicians' (statistics & numerical data)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Accessibilité des services de santé ()</term><term>Accessibilité des services de santé (économie)</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Agents antiVIH (usage thérapeutique)</term><term>Agents antiVIH (économie)</term><term>Antirétroviraux (usage thérapeutique)</term><term>Antirétroviraux (économie)</term><term>Effets secondaires indésirables des médicaments (épidémiologie)</term><term>Femelle</term><term>Ghana (épidémiologie)</term><term>Humains</term><term>Infections à VIH ()</term><term>Infections à VIH (traitement médicamenteux)</term><term>Infections à VIH (économie)</term><term>Infections à VIH (épidémiologie)</term><term>Mâle</term><term>Observance du traitement médicamenteux ()</term><term>Substitution de médicament ()</term><term>Types de pratiques des médecins ()</term><term>VIH-1 (Virus de l'Immunodéficience Humaine de type 1)</term><term>Études de cohortes</term><term>Études transversales</term></keywords><keywords scheme="MESH" type="chemical" qualifier="economics" xml:lang="en"><term>Anti-HIV Agents</term><term>Anti-Retroviral Agents</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-HIV Agents</term><term>Anti-Retroviral Agents</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Ghana</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>HIV Infections</term><term>Health Services Accessibility</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Drug-Related Side Effects and Adverse Reactions</term><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Drug Substitution</term><term>Health Services Accessibility</term><term>Medication Adherence</term><term>Practice Patterns, Physicians'</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Infections à VIH</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Agents antiVIH</term><term>Antirétroviraux</term></keywords><keywords scheme="MESH" qualifier="économie" xml:lang="fr"><term>Accessibilité des services de santé</term><term>Agents antiVIH</term><term>Antirétroviraux</term><term>Infections à VIH</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Effets secondaires indésirables des médicaments</term><term>Ghana</term><term>Infections à VIH</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Cohort Studies</term><term>Cross-Sectional Studies</term><term>Female</term><term>HIV-1</term><term>Humans</term><term>Male</term><term>Middle Aged</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Accessibilité des services de santé</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Femelle</term><term>Humains</term><term>Infections à VIH</term><term>Mâle</term><term>Observance du traitement médicamenteux</term><term>Substitution de médicament</term><term>Types de pratiques des médecins</term><term>VIH-1 (Virus de l'Immunodéficience Humaine de type 1)</term><term>Études de cohortes</term><term>Études transversales</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Ghana</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Introduction</title><p>Against the background of Ghana's ART program which scaled up rapidly since inception in 2003, the study assessed outcomes of an early cohort of patients initiating ART.</p></sec><sec id="st2"><title>Methods</title><p>The study utilized the following methods: a cross-sectional study involving patient interviews using a structured questionnaire, a review of records and a retrospective cohort analysis of adults initiating ART between 2003 and 2008 from four selected clinics.</p></sec><sec id="st3"><title>Results</title><p>The 683 study participants consisted of 464 females (67.9%) and the mean age was 41 years. Mean duration of treatment was 25 months (SD =13). More than 95% were on a regimen as per national guidelines. Ninety-five (14.1%) of the respondents had one or two drugs substituted. Seventy-three% of the substitutions were due to adverse drug reactions. On at least one occasion, over half (350) had defaulted on a clinic appointment. In the 3 months preceding the survey, 21.4% (146) had missed treatment doses. About 49% (334) had challenges meeting financial obligations related to care. The median weight increased by 5.9kg and 8.0kg at 6 and 12 months after initiating ART respectively over the median baseline weight of 54kg, (p-value = 0.001). The median CD4 count increased by 128, 170 and 256 cells/µl respectively at 6, 12 and 24 months from the median baseline of 125 cell/µl, (p-value = 0.035).</p></sec><sec id="st4"><title>Conclusion</title><p>This study of Ghanaian PLHIV on ART from four facilities showed encouraging immunological and clinical outcomes. There were however issues of appointment default, sub-optimum adherence to treatment and cost of care barriers needing attention.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Lowrance, David" uniqKey="Lowrance D">David Lowrance</name></author><author><name sortKey="Ndamage, Francois" uniqKey="Ndamage F">Francois Ndamage</name></author><author><name sortKey="Kayirangwa, Eugenie" uniqKey="Kayirangwa E">Eugenie Kayirangwa</name></author><author><name sortKey="Ndagije, Felix" uniqKey="Ndagije F">Felix Ndagije</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bussmann, Hermann" uniqKey="Bussmann H">Hermann Bussmann</name></author><author><name sortKey="Wester, William" uniqKey="Wester W">William Wester</name></author><author><name sortKey="Ndwapi, Ndwapi" uniqKey="Ndwapi N">Ndwapi 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J">JF Etard</name></author><author><name sortKey="Ndiaye, I" uniqKey="Ndiaye I">I Ndiaye</name></author><author><name sortKey="Thierry Mieg, M" uniqKey="Thierry Mieg M">M Thierry-Mieg</name></author><author><name sortKey="Gueye, Nf" uniqKey="Gueye N">NF Guèye</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stringer, Js" uniqKey="Stringer J">JS Stringer</name></author><author><name sortKey="Zulu, I" uniqKey="Zulu I">I Zulu</name></author><author><name sortKey="Levy, J" uniqKey="Levy J">J Levy</name></author><author><name sortKey="Stringer, Em" uniqKey="Stringer E">EM Stringer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Howley, Iw" uniqKey="Howley I">IW Howley</name></author><author><name sortKey="Lartey, M" uniqKey="Lartey M">M Lartey</name></author><author><name sortKey="Machan, Jt" uniqKey="Machan J">JT Machan</name></author><author><name sortKey="Talbot, Ea" uniqKey="Talbot E">EA 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uniqKey="Solberg P">P Solberg</name></author><author><name sortKey="Asiimwe, F" uniqKey="Asiimwe F">F Asiimwe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sivadasan, A" uniqKey="Sivadasan A">A Sivadasan</name></author><author><name sortKey="Abraham, Oc" uniqKey="Abraham O">OC Abraham</name></author><author><name sortKey="Rupali, P" uniqKey="Rupali P">P Rupali</name></author><author><name sortKey="Pulimood, Sa" uniqKey="Pulimood S">SA Pulimood</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="O Brien, Me" uniqKey="O Brien M">ME O'Brien</name></author><author><name sortKey="Clark, Ra" uniqKey="Clark R">RA Clark</name></author><author><name sortKey="Besch, Cl" uniqKey="Besch C">CL Besch</name></author><author><name sortKey="Myers, L" uniqKey="Myers L">L Myers</name></author><author><name sortKey="Kissinger, P" uniqKey="Kissinger P">P Kissinger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wilhelm, Ak" uniqKey="Wilhelm A">AK Wilhelm</name></author><author><name sortKey="Paci, G" uniqKey="Paci G">G Paci</name></author><author><name sortKey="Lartey, M" uniqKey="Lartey M">M Lartey</name></author><author><name sortKey="Kwara, A" uniqKey="Kwara A">A Kwara</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Boateng, Daniel" uniqKey="Boateng D">Daniel Boateng</name></author><author><name sortKey="Kwapong, Golda" uniqKey="Kwapong G">Golda Kwapong</name></author><author><name sortKey="Agyei Baffour, Peter" uniqKey="Agyei Baffour P">Peter Agyei-Baffour</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mills, Edward" uniqKey="Mills E">Edward Mills</name></author><author><name sortKey="Nachega, Jean" uniqKey="Nachega J">Jean Nachega</name></author><author><name sortKey="Bangsberg, David" uniqKey="Bangsberg D">David Bangsberg</name></author><author><name sortKey="Singh, Sonal" uniqKey="Singh S">Sonal Singh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zachariah, R" uniqKey="Zachariah R">R Zachariah</name></author><author><name sortKey="Van Engelgem, I" uniqKey="Van Engelgem I">I Van Engelgem</name></author><author><name sortKey="Massaquoi, M" uniqKey="Massaquoi M">M Massaquoi</name></author><author><name sortKey="Kocholla, L" uniqKey="Kocholla L">L Kocholla</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Huang, Laurence" uniqKey="Huang L">Laurence Huang</name></author><author><name sortKey="Crothers, Kristina" uniqKey="Crothers K">Kristina Crothers</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Foca, Emanuele" uniqKey="Foca E">Emanuele Focà</name></author><author><name sortKey="Odolini, Silvia" uniqKey="Odolini S">Silvia Odolini</name></author><author><name sortKey="Brianese, Nigritella" uniqKey="Brianese N">Nigritella Brianese</name></author><author><name sortKey="Carosi, Giampiero" uniqKey="Carosi G">Giampiero Carosi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Harish, Mr" uniqKey="Harish M">MR Harish</name></author><author><name sortKey="Shanmukhappa" uniqKey="Shanmukhappa">Shanmukhappa</name></author><author><name sortKey="Kumar, S" uniqKey="Kumar S">S Kumar</name></author><author><name sortKey="Kumar, M" uniqKey="Kumar M">M Kumar</name></author><author><name sortKey="Gowda, Ms" uniqKey="Gowda M">MS Gowda</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Koethe, Jr" uniqKey="Koethe J">JR Koethe</name></author><author><name sortKey="Lukusa, A" uniqKey="Lukusa A">A Lukusa</name></author><author><name sortKey="Giganti, Mj" uniqKey="Giganti M">MJ Giganti</name></author><author><name sortKey="Chi, Bh" uniqKey="Chi B">BH Chi</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Ghana</li><li>Zimbabwe</li></country><region><li>Région du Grand Accra</li></region><settlement><li>Accra</li><li>Legon (Ghana)</li></settlement><orgName><li>Université du Ghana</li></orgName></list><tree><country name="Ghana"><region name="Région du Grand Accra"><name sortKey="Ohene, Sally Ann" sort="Ohene, Sally Ann" uniqKey="Ohene S" first="Sally-Ann" last="Ohene">Sally-Ann Ohene</name></region><name sortKey="Addo, Nii Akwei" sort="Addo, Nii Akwei" uniqKey="Addo N" first="Nii Akwei" last="Addo">Nii Akwei Addo</name><name sortKey="Lartey, Margaret" sort="Lartey, Margaret" uniqKey="Lartey M" first="Margaret" last="Lartey">Margaret Lartey</name><name sortKey="Ndanu, Tom" sort="Ndanu, Tom" uniqKey="Ndanu T" first="Tom" last="Ndanu">Tom Ndanu</name><name sortKey="Ofori, Sampson" sort="Ofori, Sampson" uniqKey="Ofori S" first="Sampson" last="Ofori">Sampson Ofori</name><name sortKey="Romero, Maite Alfonso" sort="Romero, Maite Alfonso" uniqKey="Romero M" first="Maite Alfonso" last="Romero">Maite Alfonso Romero</name><name sortKey="Sheriff, Tania" sort="Sheriff, Tania" uniqKey="Sheriff T" first="Tania" last="Sheriff">Tania Sheriff</name><name sortKey="Zigah, Francisca" sort="Zigah, Francisca" uniqKey="Zigah F" first="Francisca" last="Zigah">Francisca Zigah</name></country><country name="Zimbabwe"><noRegion><name sortKey="Newman, Morkor" sort="Newman, Morkor" uniqKey="Newman M" first="Morkor" last="Newman">Morkor Newman</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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