Adherence and virologic suppression during the first 24 weeks on antiretroviral therapy among women in Johannesburg, South Africa - a prospective cohort study
Identifieur interne : 002218 ( Pmc/Curation ); précédent : 002217; suivant : 002219Adherence and virologic suppression during the first 24 weeks on antiretroviral therapy among women in Johannesburg, South Africa - a prospective cohort study
Auteurs : Ziad El-Khatib [Suède, Afrique du Sud] ; Anna Mia Ekstrom [Suède] ; Ashraf Coovadia [Afrique du Sud] ; Elaine J. Abrams [États-Unis] ; Max Petzold [Suède] ; David Katzenstein [États-Unis] ; Lynn Morris [Afrique du Sud] ; Louise Kuhn [États-Unis]Source :
- BMC Public Health [ 1471-2458 ] ; 2011.
Abstract
Adherence is a necessary part of successful antiretroviral treatment (ART). We assessed risk factors for incomplete adherence among a cohort of HIV-infected women initiating ART and examined associations between adherence and virologic response to ART.
A secondary data analysis was conducted on a cohort of 154 women initiating non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART at a single site in Johannesburg, South Africa. Ninety women had been enrolled in a prevention of mother-to-child transmission (pMTCT) program and were exposed to single-dose nevirapine (sdNVP) >18 months earlier. Women were interviewed pre-treatment and clinical, virologic and adherence data were collected during follow-up to 24 weeks. Incomplete adherence to ART was defined as returning >5% of medications, estimated by pill counts at scheduled visits. Multivariable logistic regression analysis and unadjusted odds ratio (95%CI) were performed, using STATA/SE (ver 10.1).
About half of the women (53%) were <30 years of age, 63% had <11 years of schooling, 69% were unemployed and 37% lived in a shack. Seven percent of women had a viral load >400 copies/ml at 24 weeks and 37% had incomplete adherence at one or more visits. Incomplete adherence was associated with less education (p = 0.01) and lack of financial support from a partner (p = 0.02) after adjustment for confounders. Only when adherence levels dropped below 80% was there a significant association with viremia in the group overall (p = 0.02) although adherence <95% was associated with viremia in the sdNVP-exposed group (p = 0.03). The main reasons for incomplete adherence were being away from home, busy with other things and forgetting to take their medication.
Virologic response to NNRTI-treatment in the cohort was excellent. However, women who received sdNVP were at greater risk of virologic failure when adherence was <95%. Women exposed to sdNVP, and those with less education and less social support may benefit from additional adherence counseling to ensure the long-term success of ART. More than 80% adherence may be sufficient to maintain virologic suppression on NNRTI-based regimens in the short-term, however complete adherence should be encouraged.
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DOI: 10.1186/1471-2458-11-88
PubMed: 21303548
PubMed Central: 3046911
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Adherence and virologic suppression during the first 24 weeks on antiretroviral therapy among women in Johannesburg, South Africa - a prospective cohort study</title><author><name sortKey="El Khatib, Ziad" sort="El Khatib, Ziad" uniqKey="El Khatib Z" first="Ziad" last="El-Khatib">Ziad El-Khatib</name><affiliation wicri:level="1"><nlm:aff id="I1">Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Division of Global Health (IHCAR), Karolinska Institutet, Stockholm</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">AIDS Virus Research Unit, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>AIDS Virus Research Unit, National Institute for Communicable Diseases (NICD), Johannesburg</wicri:regionArea></affiliation></author><author><name sortKey="Ekstrom, Anna Mia" sort="Ekstrom, Anna Mia" uniqKey="Ekstrom A" first="Anna Mia" last="Ekstrom">Anna Mia Ekstrom</name><affiliation wicri:level="1"><nlm:aff id="I1">Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Division of Global Health (IHCAR), Karolinska Institutet, Stockholm</wicri:regionArea></affiliation></author><author><name sortKey="Coovadia, Ashraf" sort="Coovadia, Ashraf" uniqKey="Coovadia A" first="Ashraf" last="Coovadia">Ashraf Coovadia</name><affiliation wicri:level="1"><nlm:aff id="I3">Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg</wicri:regionArea></affiliation></author><author><name sortKey="Abrams, Elaine J" sort="Abrams, Elaine J" uniqKey="Abrams E" first="Elaine J" last="Abrams">Elaine J. Abrams</name><affiliation wicri:level="1"><nlm:aff id="I4">International Center for AIDS Programs, Mailman School of Public Health, Columbia University, New York, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>International Center for AIDS Programs, Mailman School of Public Health, Columbia University, New York</wicri:regionArea></affiliation></author><author><name sortKey="Petzold, Max" sort="Petzold, Max" uniqKey="Petzold M" first="Max" last="Petzold">Max Petzold</name><affiliation wicri:level="1"><nlm:aff id="I5">Nordic School of Public Health (NHV), Gothenburg, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Nordic School of Public Health (NHV), Gothenburg</wicri:regionArea></affiliation></author><author><name sortKey="Katzenstein, David" sort="Katzenstein, David" uniqKey="Katzenstein D" first="David" last="Katzenstein">David Katzenstein</name><affiliation wicri:level="1"><nlm:aff id="I6">Division of Infectious Diseases, Stanford University, California, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Diseases, Stanford University, California</wicri:regionArea></affiliation></author><author><name sortKey="Morris, Lynn" sort="Morris, Lynn" uniqKey="Morris L" first="Lynn" last="Morris">Lynn Morris</name><affiliation wicri:level="1"><nlm:aff id="I2">AIDS Virus Research Unit, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>AIDS Virus Research Unit, National Institute for Communicable Diseases (NICD), Johannesburg</wicri:regionArea></affiliation></author><author><name sortKey="Kuhn, Louise" sort="Kuhn, Louise" uniqKey="Kuhn L" first="Louise" last="Kuhn">Louise Kuhn</name><affiliation wicri:level="1"><nlm:aff id="I7">Gertrude H. Sergievsky Center, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Gertrude H. Sergievsky Center, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21303548</idno><idno type="pmc">3046911</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046911</idno><idno type="RBID">PMC:3046911</idno><idno type="doi">10.1186/1471-2458-11-88</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">002219</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002219</idno><idno type="wicri:Area/Pmc/Curation">002218</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002218</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Adherence and virologic suppression during the first 24 weeks on antiretroviral therapy among women in Johannesburg, South Africa - a prospective cohort study</title><author><name sortKey="El Khatib, Ziad" sort="El Khatib, Ziad" uniqKey="El Khatib Z" first="Ziad" last="El-Khatib">Ziad El-Khatib</name><affiliation wicri:level="1"><nlm:aff id="I1">Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Division of Global Health (IHCAR), Karolinska Institutet, Stockholm</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">AIDS Virus Research Unit, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>AIDS Virus Research Unit, National Institute for Communicable Diseases (NICD), Johannesburg</wicri:regionArea></affiliation></author><author><name sortKey="Ekstrom, Anna Mia" sort="Ekstrom, Anna Mia" uniqKey="Ekstrom A" first="Anna Mia" last="Ekstrom">Anna Mia Ekstrom</name><affiliation wicri:level="1"><nlm:aff id="I1">Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Division of Global Health (IHCAR), Karolinska Institutet, Stockholm</wicri:regionArea></affiliation></author><author><name sortKey="Coovadia, Ashraf" sort="Coovadia, Ashraf" uniqKey="Coovadia A" first="Ashraf" last="Coovadia">Ashraf Coovadia</name><affiliation wicri:level="1"><nlm:aff id="I3">Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg</wicri:regionArea></affiliation></author><author><name sortKey="Abrams, Elaine J" sort="Abrams, Elaine J" uniqKey="Abrams E" first="Elaine J" last="Abrams">Elaine J. Abrams</name><affiliation wicri:level="1"><nlm:aff id="I4">International Center for AIDS Programs, Mailman School of Public Health, Columbia University, New York, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>International Center for AIDS Programs, Mailman School of Public Health, Columbia University, New York</wicri:regionArea></affiliation></author><author><name sortKey="Petzold, Max" sort="Petzold, Max" uniqKey="Petzold M" first="Max" last="Petzold">Max Petzold</name><affiliation wicri:level="1"><nlm:aff id="I5">Nordic School of Public Health (NHV), Gothenburg, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Nordic School of Public Health (NHV), Gothenburg</wicri:regionArea></affiliation></author><author><name sortKey="Katzenstein, David" sort="Katzenstein, David" uniqKey="Katzenstein D" first="David" last="Katzenstein">David Katzenstein</name><affiliation wicri:level="1"><nlm:aff id="I6">Division of Infectious Diseases, Stanford University, California, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Diseases, Stanford University, California</wicri:regionArea></affiliation></author><author><name sortKey="Morris, Lynn" sort="Morris, Lynn" uniqKey="Morris L" first="Lynn" last="Morris">Lynn Morris</name><affiliation wicri:level="1"><nlm:aff id="I2">AIDS Virus Research Unit, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>AIDS Virus Research Unit, National Institute for Communicable Diseases (NICD), Johannesburg</wicri:regionArea></affiliation></author><author><name sortKey="Kuhn, Louise" sort="Kuhn, Louise" uniqKey="Kuhn L" first="Louise" last="Kuhn">Louise Kuhn</name><affiliation wicri:level="1"><nlm:aff id="I7">Gertrude H. Sergievsky Center, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Gertrude H. Sergievsky Center, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY</wicri:regionArea></affiliation></author></analytic><series><title level="j">BMC Public Health</title><idno type="eISSN">1471-2458</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Adherence is a necessary part of successful antiretroviral treatment (ART). We assessed risk factors for incomplete adherence among a cohort of HIV-infected women initiating ART and examined associations between adherence and virologic response to ART.</p></sec><sec><title>Methods</title><p>A secondary data analysis was conducted on a cohort of 154 women initiating non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART at a single site in Johannesburg, South Africa. Ninety women had been enrolled in a prevention of mother-to-child transmission (pMTCT) program and were exposed to single-dose nevirapine (sdNVP) >18 months earlier. Women were interviewed pre-treatment and clinical, virologic and adherence data were collected during follow-up to 24 weeks. Incomplete adherence to ART was defined as returning >5% of medications, estimated by pill counts at scheduled visits. Multivariable logistic regression analysis and unadjusted odds ratio (95%CI) were performed, using STATA/SE (ver 10.1).</p></sec><sec><title>Results</title><p>About half of the women (53%) were <30 years of age, 63% had <11 years of schooling, 69% were unemployed and 37% lived in a shack. Seven percent of women had a viral load >400 copies/ml at 24 weeks and 37% had incomplete adherence at one or more visits. Incomplete adherence was associated with less education (p = 0.01) and lack of financial support from a partner (p = 0.02) after adjustment for confounders. Only when adherence levels dropped below 80% was there a significant association with viremia in the group overall (p = 0.02) although adherence <95% was associated with viremia in the sdNVP-exposed group (p = 0.03). The main reasons for incomplete adherence were being away from home, busy with other things and forgetting to take their medication.</p></sec><sec><title>Conclusion</title><p>Virologic response to NNRTI-treatment in the cohort was excellent. However, women who received sdNVP were at greater risk of virologic failure when adherence was <95%. Women exposed to sdNVP, and those with less education and less social support may benefit from additional adherence counseling to ensure the long-term success of ART. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Public Health</journal-id><journal-title-group><journal-title>BMC Public Health</journal-title></journal-title-group><issn pub-type="epub">1471-2458</issn><publisher><publisher-name>BioMed Central</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21303548</article-id><article-id pub-id-type="pmc">3046911</article-id><article-id pub-id-type="publisher-id">1471-2458-11-88</article-id><article-id pub-id-type="doi">10.1186/1471-2458-11-88</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Adherence and virologic suppression during the first 24 weeks on antiretroviral therapy among women in Johannesburg, South Africa - a prospective cohort study</article-title></title-group><contrib-group><contrib contrib-type="author" id="A1"><name><surname>El-Khatib</surname><given-names>Ziad</given-names></name><xref ref-type="aff" rid="I1">1</xref><xref ref-type="aff" rid="I2">2</xref><email>ziad.khatib@gmail.com</email></contrib><contrib contrib-type="author" id="A2"><name><surname>Ekstrom</surname><given-names>Anna Mia</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>Anna.Mia.Ekstrom@ki.se</email></contrib><contrib contrib-type="author" id="A3"><name><surname>Coovadia</surname><given-names>Ashraf</given-names></name><xref ref-type="aff" rid="I3">3</xref><email>ashraf.coovadia@wits.ac.za</email></contrib><contrib contrib-type="author" id="A4"><name><surname>Abrams</surname><given-names>Elaine J</given-names></name><xref ref-type="aff" rid="I4">4</xref><email>eja1@columbia.edu</email></contrib><contrib contrib-type="author" corresp="yes" id="A5"><name><surname>Petzold</surname><given-names>Max</given-names></name><xref ref-type="aff" rid="I5">5</xref><email>max@nhv.se</email></contrib><contrib contrib-type="author" id="A6"><name><surname>Katzenstein</surname><given-names>David</given-names></name><xref ref-type="aff" rid="I6">6</xref><email>davidkk@stanford.edu</email></contrib><contrib contrib-type="author" id="A7"><name><surname>Morris</surname><given-names>Lynn</given-names></name><xref ref-type="aff" rid="I2">2</xref><email>lynnm@nicd.ac.za</email></contrib><contrib contrib-type="author" id="A8"><name><surname>Kuhn</surname><given-names>Louise</given-names></name><xref ref-type="aff" rid="I7">7</xref><email>lk24@columbia.edu</email></contrib></contrib-group><aff id="I1"><label>1</label>Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden</aff><aff id="I2"><label>2</label>AIDS Virus Research Unit, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa</aff><aff id="I3"><label>3</label>Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</aff><aff id="I4"><label>4</label>International Center for AIDS Programs, Mailman School of Public Health, Columbia University, New York, USA</aff><aff id="I5"><label>5</label>Nordic School of Public Health (NHV), Gothenburg, Sweden</aff><aff id="I6"><label>6</label>Division of Infectious Diseases, Stanford University, California, USA</aff><aff id="I7"><label>7</label>Gertrude H. Sergievsky Center, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA</aff><pub-date pub-type="collection"><year>2011</year></pub-date><pub-date pub-type="epub"><day>8</day><month>2</month><year>2011</year></pub-date><volume>11</volume><fpage>88</fpage><lpage>88</lpage><history><date date-type="received"><day>26</day><month>11</month><year>2010</year></date><date date-type="accepted"><day>8</day><month>2</month><year>2011</year></date></history><permissions><copyright-statement>Copyright ©2011 El-Khatib et al; licensee BioMed Central Ltd.</copyright-statement><copyright-year>2011</copyright-year><copyright-holder>El-Khatib et al; licensee BioMed Central Ltd.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><self-uri xlink:href="http://www.biomedcentral.com/1471-2458/11/88"></self-uri><abstract><sec><title>Background</title><p>Adherence is a necessary part of successful antiretroviral treatment (ART). We assessed risk factors for incomplete adherence among a cohort of HIV-infected women initiating ART and examined associations between adherence and virologic response to ART.</p></sec><sec><title>Methods</title><p>A secondary data analysis was conducted on a cohort of 154 women initiating non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART at a single site in Johannesburg, South Africa. Ninety women had been enrolled in a prevention of mother-to-child transmission (pMTCT) program and were exposed to single-dose nevirapine (sdNVP) >18 months earlier. Women were interviewed pre-treatment and clinical, virologic and adherence data were collected during follow-up to 24 weeks. Incomplete adherence to ART was defined as returning >5% of medications, estimated by pill counts at scheduled visits. Multivariable logistic regression analysis and unadjusted odds ratio (95%CI) were performed, using STATA/SE (ver 10.1).</p></sec><sec><title>Results</title><p>About half of the women (53%) were <30 years of age, 63% had <11 years of schooling, 69% were unemployed and 37% lived in a shack. Seven percent of women had a viral load >400 copies/ml at 24 weeks and 37% had incomplete adherence at one or more visits. Incomplete adherence was associated with less education (p = 0.01) and lack of financial support from a partner (p = 0.02) after adjustment for confounders. Only when adherence levels dropped below 80% was there a significant association with viremia in the group overall (p = 0.02) although adherence <95% was associated with viremia in the sdNVP-exposed group (p = 0.03). The main reasons for incomplete adherence were being away from home, busy with other things and forgetting to take their medication.</p></sec><sec><title>Conclusion</title><p>Virologic response to NNRTI-treatment in the cohort was excellent. However, women who received sdNVP were at greater risk of virologic failure when adherence was <95%. Women exposed to sdNVP, and those with less education and less social support may benefit from additional adherence counseling to ensure the long-term success of ART. More than 80% adherence may be sufficient to maintain virologic suppression on NNRTI-based regimens in the short-term, however complete adherence should be encouraged.</p></sec></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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