BACKGROUND: Universal access to highly active antiretroviral therapy (HAART) is still elusive in most developing nations. We asked whether peer support influenced adherence and treatment outcome and if a single viral load (VL) could define treatment failure in a resource-limited setting. METHODS: A multicenter longitudinal and cross-sectional survey of VL, CD4 T cells, and adherence in 546 patients receiving HAART for up to 228 months. VL and CD4 counts were determined using m2000 Abbott RealTime HIV-1 assay and FACS counters, respectively. Adherence was assessed based on pill count and on self-report. RESULTS: Of the patients, 55.8%, 22.2%, and 22% had good, fair, and poor adherence, respectively. Adherence, peer support, and regimen, but not HIV disclosure, age, or gender, independently correlated with VL and durability of treatment in a multivariate analysis (P < 0.001). Treatment failure was 35.9% using sequential VL but ranged between 27% and 35% using alternate single VL cross-sectional definitions. More patients failed stavudine (41.2%) than zidovudine (37.4%) or tenofovir (28.8%, P = 0.043) treatment arms. Peer support correlated positively with adherence (χ(2), P < 0.001), with nonadherence being highest in the stavudine arm. VL before the time of regimen switch was comparable between patients switching and not switching treatment. Moreover, 36% of those switching still failed the second-line regimen. CONCLUSION: Weak adherence support and inaccessible VL testing threaten to compromise the success of HAART scale-up in Kenya. To hasten antiretroviral therapy monitoring and decision making, we suggest strengthening patient-focused adherence programs, optimizing and aligning regimen to WHO standards, and a single point-of-care VL testing when multiple tests are unavailable.
BACKGROUND: Universal access to highly active antiretroviral therapy (HAART) is still elusive in most developing nations. We asked whether peer support influenced adherence and treatment outcome and if a single viral load (VL) could define treatment failure in a resource-limited setting. METHODS: A multicenter longitudinal and cross-sectional survey of VL, CD4 T cells, and adherence in 546 patients receiving HAART for up to 228 months. VL and CD4 counts were determined using m2000 Abbott RealTime HIV-1 assay and FACS counters, respectively. Adherence was assessed based on pill count and on self-report. RESULTS: Of the patients, 55.8%, 22.2%, and 22% had good, fair, and poor adherence, respectively. Adherence, peer support, and regimen, but not HIV disclosure, age, or gender, independently correlated with VL and durability of treatment in a multivariate analysis (P < 0.001). Treatment failure was 35.9% using sequential VL but ranged between 27% and 35% using alternate single VL cross-sectional definitions. More patients failed stavudine (41.2%) than zidovudine (37.4%) or tenofovir (28.8%, P = 0.043) treatment arms. Peer support correlated positively with adherence (χ(2), P < 0.001), with nonadherence being highest in the stavudine arm. VL before the time of regimen switch was comparable between patients switching and not switching treatment. Moreover, 36% of those switching still failed the second-line regimen. CONCLUSION: Weak adherence support and inaccessible VL testing threaten to compromise the success of HAART scale-up in Kenya. To hasten antiretroviral therapy monitoring and decision making, we suggest strengthening patient-focused adherence programs, optimizing and aligning regimen to WHO standards, and a single point-of-care VL testing when multiple tests are unavailable.
Authors: Anthony D Harries; Rony Zachariah; Joep J van Oosterhout; Steven D Reid; Mina C Hosseinipour; Vic Arendt; Zengani Chirwa; Andreas Jahn; Erik J Schouten; Kelita Kamoto Journal: Lancet Infect Dis Date: 2010-01 Impact factor: 25.071
Authors: Claude A Mellins; Katherine Tassiopoulos; Kathleen Malee; Anna-Barbara Moscicki; Doyle Patton; Renee Smith; Ann Usitalo; Susannah M Allison; Russell Van Dyke; George R Seage Journal: AIDS Patient Care STDS Date: 2011-05-05 Impact factor: 5.078
Authors: Ravindra K Gupta; Andrew Hill; Anthony W Sawyer; Alessandro Cozzi-Lepri; Viktor von Wyl; Sabine Yerly; Viviane Dias Lima; Huldrych F Günthard; Charles Gilks; Deenan Pillay Journal: Lancet Infect Dis Date: 2009-07 Impact factor: 25.071
Authors: Ziad El-Khatib; Anna Mia Ekstrom; Ashraf Coovadia; Elaine J Abrams; Max Petzold; David Katzenstein; Lynn Morris; Louise Kuhn Journal: BMC Public Health Date: 2011-02-08 Impact factor: 3.295
Authors: Ruth S Mwatelah; Raphael M Lwembe; Saida Osman; Bernhards R Ogutu; Rashid Aman; Rose C Kitawi; Laura N Wangai; Florence A Oloo; Gilbert O Kokwaro; Washingtone Ochieng Journal: PLoS One Date: 2015-07-24 Impact factor: 3.240
Authors: Rose C Kitawi; Carol W Hunja; Rashid Aman; Bernhards R Ogutu; Anne W T Muigai; Gilbert O Kokwaro; Washingtone Ochieng Journal: Virol J Date: 2017-02-14 Impact factor: 4.099
Authors: Maureen J Kimulwo; Javan Okendo; Rashid A Aman; Bernhards R Ogutu; Gilbert O Kokwaro; Dorothy J Ochieng; Anne W T Muigai; Florence A Oloo; Washingtone Ochieng Journal: PLoS One Date: 2017-02-24 Impact factor: 3.240
Authors: Nang Thu Thu Kyaw; Anthony D Harries; Ajay M V Kumar; Myo Minn Oo; Khine Wut Yee Kyaw; Than Win; Thet Ko Aung; Aung Chan Min; Htun Nyunt Oo Journal: PLoS One Date: 2017-02-09 Impact factor: 3.240
Authors: Sabrina K Been; Elif Yildiz; Pythia T Nieuwkerk; Katalin Pogány; David A M C van de Vijver; Annelies Verbon Journal: PLoS One Date: 2017-11-09 Impact factor: 3.240
Authors: Dominic Bukenya; Billy Nsubuga Mayanja; Sarah Nakamanya; Richard Muhumuza; Janet Seeley Journal: AIDS Res Ther Date: 2019-01-21 Impact factor: 2.250