Pharmacy refill adherence outperforms self-reported methods in predicting HIV therapy outcome in resource-limited settings
Raphael Z. Sangeda,Raphael Z. Sangeda,Fausta Mosha,Fausta Mosha,Mattia Prosperi,Said Aboud,Jurgen Vercauteren,Jurgen Vercauteren,Ricardo Jorge Camacho,Ricardo Jorge Camacho,Eligius Lyamuya,Eric Van Wijngaerden,Anne-Mieke Vandamme,Anne-Mieke Vandamme +13 more
TLDR
Pharmacy refill adherence emerged as the best method for predicting virological failure and to identify patients to be considered for viral load monitoring and HIVDR testing in RLS.Abstract:
Optimal adherence to antiretroviral therapy is critical to prevent HIV drug resistance (HIVDR) epidemic. The objective of the study was to investigate the best performing adherence assessment method for predicting virological failure in resource-limited settings (RLS). This study was a single-centre prospective cohort, enrolling 220 HIV-infected adult patients attending an HIV/AIDS Care and Treatment Centre in Dar es Salaam, Tanzania, in 2010. Pharmacy refill, self-report (via visual analog scale [VAS] and the Swiss HIV Cohort study-adherence questionnaire), pill count, and appointment keeping adherence measurements were taken. Univariate logistic regression (LR) was done to explore a cut-off that gives a better trade-off between sensitivity and specificity, and a higher area under the curve (AUC) based on receiver operating characteristic curve in predicting virological failure. Additionally, the adherence models were evaluated by fitting multivariate LR with stepwise functions, decision trees, and random forests models, assessing 10-fold multiple cross validation (MCV). Patient factors associated with virological failure were determined using LR. Viral load measurements at baseline and one year after recruitment were available for 162 patients, of whom 55 (34%) had detectable viral load and 17 (10.5%) had immunological failure at one year after recruitment. The optimal cut-off points significantly predictive of virological failure were 95%, 80%, 95% and 90% for VAS, appointment keeping, pharmacy refill, and pill count adherence respectively. The AUC for these methods ranged from 0.52 to 0.61, with pharmacy refill giving the best performance at AUC 0.61. Multivariate logistic regression with boost stepwise MCV had higher AUC (0.64) compared to all univariate adherence models, except pharmacy refill adherence univariate model, which was comparable to the multivariate model (AUC = 0.64). Decision trees and random forests models were inferior to boost stepwise model. Pharmacy refill adherence (<95%) emerged as the best method for predicting virological failure. Other significant predictors in multivariate LR were having a baseline CD4 T lymphocytes count < 200 cells/μl, being unable to recall the diagnosis date, and a higher weight. Pharmacy refill has the potential to predict virological failure and to identify patients to be considered for viral load monitoring and HIVDR testing in RLS.read more
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Adherence to Antiretroviral Therapy (ART) in Yaoundé-Cameroon: Association with Opportunistic Infections, Depression, ART Regimen and Side Effects.
Julius Y. Fonsah,Alfred K. Njamnshi,Charles Kouanfack,Fang Qiu,Dora M. Njamnshi,Claude Tayou Tagny,Emilienne Nchindap,Léopoldine Kenmogne,Dora Mbanya,Robert K. Heaton,Georgette D. Kanmogne +10 more
TL;DR: It is demonstrated that drug side-effects, low CD4 cell counts and higher viral loads are associated with increased risk of non-adherence, and compared to females, males were more likely to forego ART because of side effects, and addressed these underlying risk factors could improve ART adherence, retention in care and treatment outcomes for HIV/AIDS patients in Cameroon.
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Desarrollo y evaluación de cuestionario multidimensional para medir no-adhesión al tratamiento con medicamentos
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Psychosocial interventions enhance HIV medication adherence: A systematic review and meta-analysis.
TL;DR: This meta-analysis study concludes that various psychosocial interventions can improve medication adherence and thereby the health of people living with HIV.
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Pharmacists and medication adherence in asthma: a systematic review and meta-analysis
Marissa Ayano Mes,Caroline Brigitte Katzer,Amy Hai Yan Chan,Vari Wileman,Stephanie Jane Caroline Taylor,Rob Horne +5 more
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Multimonth dispensing of up to 6 months of antiretroviral therapy in Malawi and Zambia (INTERVAL): a cluster-randomised, non-blinded, non-inferiority trial
Risa M Hoffman,Crispin Moyo,Kelvin Balakasi,Zumbe Siwale,Julie Hubbard,Ashley Bardon,Matthew P. Fox,Gift Kakwesa,Thokozani Kalua,Mwiza Nyasa-Haambokoma,Kathryn Dovel,Paula M Campbell,Chi-Hong Tseng,Pedro T. Pisa,Refiloe Cele,Sundeep Gupta,Mariet Benade,Lawrence Long,Thembi Xulu,Ian Sanne,Sydney Rosen,Sydney Rosen +21 more
TL;DR: In this article, the authors did a pragmatic, cluster-randomised, unblinded, non-inferiority trial (INTERVAL) at 30 health facilities in Malawi and Zambia.
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