Matthew P Fox1,2,3, Rebecca Berhanu1,4, Kim Steegen5, Cindy Firnhaber4,6, Prudence Ive6, David Spencer4, Sello Mashamaite4, Sadiyya Sheik7, Ingrid Jonker8, Pauline Howell5, Lawrence Long1, Denise Evans1. 1. Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 2. Department of Global Health, Boston University School of Public Health, Boston, MA, USA. 3. Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA. 4. Right to Care, Johannesburg, South Africa. 5. Department of Haematology and Molecular Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 6. Clinical HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 7. Task Applied Science, Cape Town, South Africa. 8. Witkoppen Health and Welfare Center, Johannesburg, South Africa.
Abstract
OBJECTIVE: In resource-limited settings, where genotypic drug resistance testing is rarely performed and poor adherence is the most common reason for treatment failure, programmatic approaches to handling treatment failure are essential. This study was performed to describe one such approach to adherence optimisation. METHODS: This was a single-arm study of patients on second-line protease inhibitor (PI)-based antiretroviral therapy (ART) with a HIV-1 RNA ≥400 copies/ml in Johannesburg, South Africa, between 1 March 2012 and 1 December 2013. Patients underwent enhanced adherence counselling. Those with improved adherence and a repeat viral load of >1000 copies/ml underwent HIV-1 drug resistance testing. We describe results using simple proportions and 95% confidence intervals. RESULTS: Of the 400 patients who underwent targeted adherence counselling after an elevated viral load on second-line ART, 388 (97%) underwent repeat viral load testing. Most of these (n = 249; 64%, 95% CI 59-69) resuppressed (<400 copies/ml) on second line. By the end of follow-up (1 March 2014), among the 139 (36%, 95% CI: 31-41%), who did not initially resuppress after being targeted, 106 had a viral load >400 copies/ml, 11 switched to third line, 5 were awaiting third line, 4 had died and 13 were lost to follow-up. Among the unsuppressed, 48 successfully underwent resistance testing with some resistance detected in most (41/48). CONCLUSIONS: Most (64%) second-line treatment failure in this clinic is related to adherence and can be overcome with careful adherence support. Controlled interventions are needed to determine what the optimal approach is to improving second-line outcomes and reducing the need for third-line ART.
OBJECTIVE: In resource-limited settings, where genotypic drug resistance testing is rarely performed and poor adherence is the most common reason for treatment failure, programmatic approaches to handling treatment failure are essential. This study was performed to describe one such approach to adherence optimisation. METHODS: This was a single-arm study of patients on second-line protease inhibitor (PI)-based antiretroviral therapy (ART) with a HIV-1 RNA ≥400 copies/ml in Johannesburg, South Africa, between 1 March 2012 and 1 December 2013. Patients underwent enhanced adherence counselling. Those with improved adherence and a repeat viral load of >1000 copies/ml underwent HIV-1 drug resistance testing. We describe results using simple proportions and 95% confidence intervals. RESULTS: Of the 400 patients who underwent targeted adherence counselling after an elevated viral load on second-line ART, 388 (97%) underwent repeat viral load testing. Most of these (n = 249; 64%, 95% CI 59-69) resuppressed (<400 copies/ml) on second line. By the end of follow-up (1 March 2014), among the 139 (36%, 95% CI: 31-41%), who did not initially resuppress after being targeted, 106 had a viral load >400 copies/ml, 11 switched to third line, 5 were awaiting third line, 4 had died and 13 were lost to follow-up. Among the unsuppressed, 48 successfully underwent resistance testing with some resistance detected in most (41/48). CONCLUSIONS: Most (64%) second-line treatment failure in this clinic is related to adherence and can be overcome with careful adherence support. Controlled interventions are needed to determine what the optimal approach is to improving second-line outcomes and reducing the need for third-line ART.
Keywords:
Afrique subsaharienne; HIV genotyping; antiretroviral therapy; fallo en el tratamiento; fallo virológico; genotipaje del VIH; génotypage du VIH; inhibidor de proteasas; inhibiteur de protéase; lopinavir; protease inhibitor; second-line antiretroviral therapy; sub-Saharan Africa; third-line antiretroviral therapy; thérapie antirétrovirale; traitement antirétroviral de deuxième ligne; traitement antirétroviral de troisième ligne; tratamiento antirretroviral; tratamiento antirretroviral de segunda línea; tratamiento antirretroviral de tercera línea; treatment failure; virologic failure; África subsahariana; échec du traitement; échec virologique
Authors: Caitlin M Dugdale; Andrea L Ciaranello; Linda-Gail Bekker; Madeline E Stern; Landon Myer; Robin Wood; Paul E Sax; Elaine J Abrams; Kenneth A Freedberg; Rochelle P Walensky Journal: Ann Intern Med Date: 2019-04-02 Impact factor: 25.391
Authors: Denise Evans; Sara Dahlberg; Rebecca Berhanu; Tembeka Sineke; Caroline Govathson; Ingrid Jonker; Elisabet Lönnermark; Matthew P Fox Journal: AIDS Care Date: 2018-02-21
Authors: Beatriz Grinsztejn; Michael D Hughes; Justin Ritz; Robert Salata; Peter Mugyenyi; Evelyn Hogg; Linda Wieclaw; Robert Gross; Catherine Godfrey; Sandra W Cardoso; Aggrey Bukuru; Mumbi Makanga; Sharlaa Faesen; Vidya Mave; Beatrice Wangari Ndege; Sandy Nerette Fontain; Wadzanai Samaneka; Rode Secours; Marije van Schalkwyk; Rosie Mngqibisa; Lerato Mohapi; Javier Valencia; Patcharaphan Sugandhavesa; Esmelda Montalban; Anchalee Avihingsanon; Breno R Santos; Nagalingeswaran Kumarasamy; Cecilia Kanyama; Robert T Schooley; John W Mellors; Carole L Wallis; Ann C Collier Journal: Lancet HIV Date: 2019-07-29 Impact factor: 12.767
Authors: Cleophas Chimbetete; David Katzenstein; Tinei Shamu; Adrian Spoerri; Janne Estill; Matthias Egger; Olivia Keiser Journal: Open Forum Infect Dis Date: 2018-02-02 Impact factor: 3.835
Authors: Olivier Ségéral; Eric Nerrienet; Sansothy Neth; Bruno Spire; Vohith Khol; Laurent Ferradini; Saramony Sarun; Chandara Mom; Sopheak Ngin; Charlotte Charpentier; Pagnaroat Men; Marion Mora; Vun Mean Chhi; Penhsun Ly; Vonthanak Saphonn Journal: Front Public Health Date: 2018-03-19
Authors: Alexander J Stockdale; Matthew J Saunders; Mark A Boyd; Laura J Bonnett; Victoria Johnston; Gilles Wandeler; Annelot F Schoffelen; Laura Ciaffi; Kristen Stafford; Ann C Collier; Nicholas I Paton; Anna Maria Geretti Journal: Clin Infect Dis Date: 2018-06-01 Impact factor: 9.079
Authors: Denise Evans; Kamban Hirasen; Rebecca Berhanu; Given Malete; Prudence Ive; David Spencer; Sharlaa Badal-Faesen; Ian M Sanne; Matthew P Fox Journal: AIDS Res Ther Date: 2018-04-10 Impact factor: 2.250