OBJECTIVE: To evaluate treatment results of the paying antiretroviral therapy (ART) clinic of Queen Elizabeth Central Hospital, a large public and teaching hospital in Blantyre, Malawi. The only ART was a fixed drug combination of stavudine, lamivudine and nevirapine. METHODS: Cross sectional study with interviews, laboratory tests (CD4 count, viral load, nevirapine plasma levels, transaminases) and data extraction from files. RESULTS: A total of 422 (59%) of the patients who started ART since 2000 were lost to follow-up. The 176 patients enrolled in the study had good virological and excellent clinical treatment results. The most common side effect was peripheral neuropathy. Nevirapine plasma levels were remarkably high and associated with successful virological treatment results. Two simple adherence questions pertaining to the use of medication in the previous 8 days corresponded well with nevirapine levels. The most important reasons for non-adherence were shortage of drugs in the hospital pharmacy and personal financial constraints. CONCLUSIONS: (1) Many patients were lost to follow-up. (2) High nevirapine levels contributed to good therapy results in those studied. (3) Simple adherence questions predicted subtherapeutic nevirapine levels. (4) Antiretroviral drug supply needs to be uninterrupted and free of charge, to prevent avoidable non-adherence.
OBJECTIVE: To evaluate treatment results of the paying antiretroviral therapy (ART) clinic of Queen Elizabeth Central Hospital, a large public and teaching hospital in Blantyre, Malawi. The only ART was a fixed drug combination of stavudine, lamivudine and nevirapine. METHODS: Cross sectional study with interviews, laboratory tests (CD4 count, viral load, nevirapine plasma levels, transaminases) and data extraction from files. RESULTS: A total of 422 (59%) of the patients who started ART since 2000 were lost to follow-up. The 176 patients enrolled in the study had good virological and excellent clinical treatment results. The most common side effect was peripheral neuropathy. Nevirapine plasma levels were remarkably high and associated with successful virological treatment results. Two simple adherence questions pertaining to the use of medication in the previous 8 days corresponded well with nevirapine levels. The most important reasons for non-adherence were shortage of drugs in the hospital pharmacy and personal financial constraints. CONCLUSIONS: (1) Many patients were lost to follow-up. (2) High nevirapine levels contributed to good therapy results in those studied. (3) Simple adherence questions predicted subtherapeutic nevirapine levels. (4) Antiretroviral drug supply needs to be uninterrupted and free of charge, to prevent avoidable non-adherence.
Authors: Elvin H Geng; David V Glidden; David R Bangsberg; Mwebesa Bosco Bwana; Nicholas Musinguzi; Denis Nash; John Z Metcalfe; Constantin T Yiannoutsos; Jeffrey N Martin; Maya L Petersen Journal: Am J Epidemiol Date: 2012-02-03 Impact factor: 4.897
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Authors: Norma C Ware; John Idoko; Sylvia Kaaya; Irene Andia Biraro; Monique A Wyatt; Oche Agbaji; Guerino Chalamilla; David R Bangsberg Journal: PLoS Med Date: 2009-01-27 Impact factor: 11.069
Authors: Stefan Hanson; Anna Thorson; Hans Rosling; Claes Ortendahl; Claudia Hanson; Japhet Killewo; Anna Mia Ekström Journal: PLoS One Date: 2009-04-17 Impact factor: 3.240
Authors: Elena Losina; Hapsatou Touré; Lauren M Uhler; Xavier Anglaret; A David Paltiel; Eric Balestre; Rochelle P Walensky; Eugène Messou; Milton C Weinstein; François Dabis; Kenneth A Freedberg Journal: PLoS Med Date: 2009-10-27 Impact factor: 11.069