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Liao R, Tang Z, Zhang N, Hu L, Chang Z, Ren J, Bai X, Shi J, Fan S, Pei R, Du L, Zhang T. Discrepancies between self-reported medication in adherence and indirect measurement adherence among patients undergoing antiretroviral therapy: a systematic review. Infect Dis Poverty 2024; 13:51. [PMID: 38970140 DOI: 10.1186/s40249-024-01221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 06/24/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Given the critical importance of medication adherence in HIV/AIDS treatment, this study aims to compare medication adherence measured by self-report (SR) and indirect measurement among antiretroviral therapy (ART) patients, exploring the differences of adherence results measured by different tools. METHODS We systematically searched PubMed, Embase, and the Cochrane Library to identify all relevant literature published up to November 22, 2023, without language restrictions, reporting adherence to ART measured by both SR and indirect measurement methods, while also analyzing individual and group adherence separately. Discrepancies between SR and indirect measurement results were assessed using the Mann-Whitney U test or Wilcoxon signed-rank test, with correlations evaluated using the Pearson correlation coefficient. Following one-to-one comparisons, meta-epidemiological one-step analysis was conducted, and network meta-analysis techniques were applied to compare results obtained through specific adherence assessment tools reported in the identified articles. RESULTS The analysis encompassed 65 original studies involving 13,667 HIV/AIDS patients, leading to 112 one-to-one comparisons between SR and indirect measurement tools. Statistically significant differences were observed between SR and indirect measurement tools regarding both individual and group adherence (P < 0.05), with Pearson correlation coefficients of 0.843 for individual adherence and 0.684 for group adherence. During meta-epidemiological one-step analysis, SR-measured adherence was determined to be 3.94% (95% CI: -4.48-13.44%) higher for individual adherence and 16.14% (95% CI: 0.81-18.84%) higher for group adherence compared to indirectly measured results. Subgroup analysis indicated that factors such as the year of reporting and geographic region appeared to influence the discrepancies between SR and indirect measurements. Furthermore, network meta-analysis revealed that for both individual and group adherence, the results obtained from most SR and indirect measurement tools were higher than those from electronic monitoring devices, with some demonstrating statistical significance (P < 0.05). CONCLUSIONS The findings underscored the complexity of accurately measuring medication adherence among ART patients. Significant variability was observed across studies, with self-report methods showing a significant tendency towards overestimation. Year of reporting, geographic region, and adherence measurement tools appeared to influence the differences between SR and indirect measurements. Future research should focus on developing and validating integrated adherence measurements that can combine SR data with indirect measures to achieve a more comprehensive understanding of adherence behaviors.
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Affiliation(s)
- Rujun Liao
- Center of Infectious Diseases, Research Center of Clinical Epidemiology and Evidence-Based Medicine, Innovation Insititute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zihuan Tang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Na Zhang
- Center of Infectious Diseases, Research Center of Clinical Epidemiology and Evidence-Based Medicine, Innovation Insititute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Lin Hu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zongqi Chang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jiayi Ren
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xuefei Bai
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jinhong Shi
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, People's Republic of China
| | - Sisi Fan
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, People's Republic of China
| | - Rong Pei
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, 611130, Sichuan, People's Republic of China
| | - Liang Du
- Center of Infectious Diseases, Research Center of Clinical Epidemiology and Evidence-Based Medicine, Innovation Insititute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Tao Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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Scott NA, Sadowski C, Vernon A, Arevalo B, Beer K, Borisov A, Cayla JA, Chen M, Feng PJ, Moro RN, Holland DP, Martinson N, Millet JP, Miro JM, Belknap R. Using a medication event monitoring system to evaluate self-report and pill count for determining treatment completion with self-administered, once-weekly isoniazid and rifapentine. Contemp Clin Trials 2023; 129:107173. [PMID: 37004811 PMCID: PMC11078335 DOI: 10.1016/j.cct.2023.107173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/20/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Treatment completion is essential for the effectiveness of any latent tuberculosis infection (LTBI) regimen. The Tuberculosis Trials Consortium (TBTC) Study 33 (iAdhere) combined self-report and pill counts - standard of care (SOC) with a medication event monitoring system (MEMS) to determine treatment completion for 12-dose once-weekly isoniazid and rifapentine (3HP). Understanding the performance of SOC relative to MEMS can inform providers and suggest when interventions may be applied to optimize LTBI treatment completion. METHOD iAdhere randomized participants to directly observed therapy (DOT), SAT, or SAT with text reminders in Hong Kong, South Africa, Spain and the United States (U.S.). This post-hoc secondary analysis evaluated treatment completion in both SAT arms, and compared completion based on SOC with MEMS to completion based on SOC only. Treatment completion proportions were compared. Characteristics associated with discordance between SOC and SOC with MEMS were identified. RESULTS Overall 80.8% of 665 participants completed treatment per SOC, compared to 74.7% per SOC with MEMS, a difference of 6.1% (95%CI: 4.2%, 7.8%). Among U.S. participants only, this difference was 3.3% (95% CI: 1.8%, 4.9%). Differences in completion was 3.1% (95% CI: -1.1%, 7.3%) in Spain, and 36.8% (95% CI: 24.3%, 49.4%) in South Africa. There was no difference in Hong Kong. CONCLUSION When used for monitoring 3HP, SOC significantly overestimated treatment completion in U.S. and South Africa. However, SOC still provides a reasonable estimate of treatment completion of the 3HP regimen, in U.S., Spain, and Hong Kong.
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Affiliation(s)
- Nigel A Scott
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA.
| | - Claire Sadowski
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Andrew Vernon
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | | | - Karlyn Beer
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Andrey Borisov
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Joan A Cayla
- Foundation of TB Research Unit of Barcelona, Barcelona, Spain
| | - Michael Chen
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Pei-Jean Feng
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Ruth N Moro
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | | | - Neil Martinson
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, South Africa and Johns Hopkins University Center for TB Research, Baltimore, MD, USA
| | - Joan-Pau Millet
- Agència de Salut Pública de Barcelona, Spain; CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Jose M Miro
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Robert Belknap
- Public Health Institute at Denver Health, Denver, CO, USA
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Nasomsong W, Phokaphol K, Changpradub D. First-Line Antiretroviral Regimen Failure and Determinants in an Urban HIV Clinic at Phramongkutklao Hospital, Bangkok, Thailand: 20 Years Experience. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:261-269. [PMID: 33692637 PMCID: PMC7939509 DOI: 10.2147/hiv.s295512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/26/2021] [Indexed: 11/23/2022]
Abstract
Purpose HIV treatment involves antiretroviral therapy (ART) endeavoring to suppress viral load to an undetectable level. Virologic failure occurs when ART fails to suppress and sustain an individual’s viral load to less than 200 copies/mL after 6 months of therapy. In Thailand, the data among first-line antiretroviral regimen failure and determinants remains limited, especially in urban HIV clinics. We aimed to demonstrate factors of first-line antiretroviral regimen failures in an urban HIV/AIDS clinic at Phramongkutklao Hospital. Patients and Methods A nested case control 1:4 study was conducted. Data were collected from the electronic patient database among naïve people living with HIV/AIDS (PLWHA), aged ≥18 years and receiving ART continuously for at least 2 years at Phramongkutklao Hospital from 1 January 2000 to 31 December 2019. Multiple logistic regression was used to identify the determinants of virologic failure. Adjusted HRs (AHRs) with 95% CIs were used to declare statistical significance. Results Of 200 PLWHA included in the study, 40 participants experienced HIV virologic failure. The median time after starting ART to virologic failure was 24 months (IQR 7–96.0). Univariate and multivariate analysis showed significant factors affecting first-line antiretroviral regimen failure included being female (37.5 vs 26.88%, adjusted odds ratio 5.08 [1.05–24.6, p-value 0.043], age ≤40 yr. (62.5 vs 49.6%, adjusted odds ratio 4.59 [1.47–14.37], p-value 0.009), CD4+count ≤200 cell/µL (77.5 vs 52.5%, adjusted odds ratio 4.83 [1.28–18.9], p value 0.02), tuberculosis (42.5 vs 7.5%, adjusted odds ratio 8.66 [2.37–31.56], p value <0.001) and initiation of ART at CD4+ count <350 cell/µL (72.5 vs 48.13%, adjusted odds ratio 31.36 [6.51–151.22], p value <0.001). Estimated prevalence of virologic failure in Phramongkutklao Hospital was 5.34%. Conclusion Our study revealed factors favoring virologic failure included being female, younger age, CD4+ count <200 cells/µL, tuberculosis and initiation of ART at CD4+ count <350 cell/µL. Multidisciplinary HIV comprehensive care teams should encourage patient adherence and support patients along HIV continuum of care to prevent virologic failure and drug resistance, especially among patients initiating ART at low CD4+ count and tuberculosis co-infection.
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Affiliation(s)
- Worapong Nasomsong
- Division of Infectious Diseases, Department of Internal Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Kwonchit Phokaphol
- Division of Infectious Diseases, Department of Internal Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Dhitiwat Changpradub
- Division of Infectious Diseases, Department of Internal Medicine, Phramongkutklao Hospital, Bangkok, Thailand
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Ssewamala FM, Dvalishvili D, Mellins CA, Geng EH, Makumbi F, Neilands TB, McKay M, Damulira C, Nabunya P, Sensoy Bahar O, Nakigozi G, Kigozi G, Byansi W, Mukasa M, Namuwonge F. The long-term effects of a family based economic empowerment intervention (Suubi+Adherence) on suppression of HIV viral loads among adolescents living with HIV in southern Uganda: Findings from 5-year cluster randomized trial. PLoS One 2020; 15:e0228370. [PMID: 32040523 PMCID: PMC7010288 DOI: 10.1371/journal.pone.0228370] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The rapid scale-up of HIV therapy across Africa has failed to adequately engage adolescents living with HIV (ALWHIV). Retention and viral suppression for this group (ALWHIV) is 50% lower than for adults. Indeed, on the African continent, HIV remains the single leading cause of mortality among adolescents. Strategies tailored to the unqiue developmental and social vulnerabilities of this group are urgently needed to enhance successful treatment. METHODS We carried out a five-year longitudinal cluster randomized trial (ClinicalTrials.gov ID: NCT01790373) with adolescents living with HIV (ALWHIV) ages 10 to 16 years clustered at health care clinics to test the effect of a family economic empowerment (EE) intervention on viral suppression in five districuts in Uganda. In total, 39 accredited health care clinics from study districts with existing procedures tailored to adolescent adherence were eligible to participate in the trial. We used data from 288 youth with detectable HIV viral loads (VL) at baseline (158 -intervention group from 20 clinics, 130 -non-intervention group from 19 clinics). The primary end point was undetectable plasma HIV RNA levels, defined as < 40 copies/ml. We used Kaplan-Meier (KM) analysis and Cox proportional hazard models to estimate intervention effects. FINDINGS The Kaplan-Meier (KM) analysis indicated that an incidence of undetectable VL (0.254) was significantly higher in the intervention condition compared to 0.173 (in non-intervention arm) translated into incidence rate ratio of 1.468 (CI: 1.064-2.038), p = 0.008. Cox regression results showed that along with the family-based EE intervention (adj. HR = 1.446, CI: 1.073-1.949, p = 0.015), higher number of medications per day had significant positive effects on the viral suppression (adj.HR = 1.852, CI: 1.275-2.690, p = 0.001). INTERPRETATION A family economic empowerment intervention improved treatment success for ALWHIV in Uganda. Analyses of cost effectiveness and scalability are needed to advance incorporation of this intervention into routine practice in low and middle-income countries.
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Affiliation(s)
- Fred M. Ssewamala
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States of America
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- SMART Africa Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- * E-mail:
| | - Darejan Dvalishvili
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Claude A. Mellins
- Department of Psychiatry, New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies at Columbia University Medical Center, The City of New York, NY, United States of America
| | - Elvin H. Geng
- Division of Infectious Diseases, John T. Milliken Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO, United States of America
| | | | - Torsten B. Neilands
- Division of Prevention Science, Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Mary McKay
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- SMART Africa Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Christopher Damulira
- International Center for Child Health and Development (ICHAD), Uganda Office, Masaka, Uganda
| | - Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
- SMART Africa Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | | | | | - William Byansi
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Miriam Mukasa
- International Center for Child Health and Development (ICHAD), Uganda Office, Masaka, Uganda
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Uganda Office, Masaka, Uganda
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Arce Rentería M, Byrd D, Coulehan K, Miranda C, Fuentes A, Rosario AK, Morris EP, Rivera Mindt M. Neurocognitive intra-individual variability within HIV+ adults with and without current substance use. Neuropsychology 2019; 34:321-330. [PMID: 31886690 DOI: 10.1037/neu0000612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE HIV infection and current substance use (SU) are linked to cognitive and functional deficits, yet findings on their combined effects are mixed. Neurocognitive intraindividual variability, measured as dispersion of scores across a neuropsychological battery, is associated with worse cognitive outcomes and functional deficits among HIV+ adults but has not been studied in the context of HIV+ adults with current SU. We hypothesized that, among HIV+ adults, current SU would be associated with greater dispersion, that greater dispersion would be associated with worse medication adherence, and that this relationship would be worse among substance users. METHOD Forty HIV+ adults completed neuropsychological, psychiatric, SU, and medical evaluations and an electronic medication adherence measure. General linear models evaluated the main effect of SU status on neurocognitive dispersion, and models stratified by SU status evaluated the effect of dispersion on medication adherence, adjusting for relevant covariates. RESULTS The SU+ group showed greater dispersion than did the SU- group, t(38) = 2.74, p = .049, d = 0.81, but this association did not survive multiple comparisons. Stratified analyses indicated a negative relationship between dispersion and medication adherence among the SU+ group but not in the SU- group; however, this effect was reduced after accounting for depressive symptoms. CONCLUSIONS We found preliminary evidence that current SU is associated with greater neurocognitive dispersion among HIV+ adults. SU and neurocognitive dispersion may have a synergistic effect on medication adherence; however, this effect is largely accounted for by depressive symptoms. Future research should examine progression of dispersion in HIV and consequent neurocognitive and functional deficits in those with current SU. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Bionghi N, Daftary A, Maharaj B, Msibi Z, Amico KR, Friedland G, Orrell C, Padayatchi N, O'Donnell MR. Pilot evaluation of a second-generation electronic pill box for adherence to Bedaquiline and antiretroviral therapy in drug-resistant TB/HIV co-infected patients in KwaZulu-Natal, South Africa. BMC Infect Dis 2018; 18:171. [PMID: 29642874 PMCID: PMC5896111 DOI: 10.1186/s12879-018-3080-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The introduction of Bedaquiline, the first new antimycobacterial drug in over 40 years, has highlighted the critical importance of medication adherence in drug-resistant tuberculosis (DR-TB) treatment to prevent amplified drug-resistance and derive sustained benefit. Real-time electronic dose monitoring (EDM) accurately measures adherence and allows for titration of adherence support for anti-retroviral therapy (ART). The goal of this study was to evaluate the accuracy and acceptability of a next-generation electronic pillbox (Wisepill RT2000) for Bedaquiline-containing TB regimens. METHODS Eligible patients were DR-TB/HIV co-infected adults hospitalized for the initiation of Bedaquiline-containing treatment regimens in KwaZulu-Natal, South Africa. A one-way crossover design was used to evaluate levels of adherence and patient acceptance of EDM. Each patient was given a Wisepill device which was filled with ART, Levofloxacin or Bedaquiline over three consecutive weeks. Medication adherence was measured using Wisepill counts, patient-reported seven-day recall, and weekly pill count. An open-ended qualitative questionnaire at the end of the study evaluated participant acceptability of the Wisepill device. RESULTS We enrolled 21 DR-TB/HIV co-infected inpatients admitted for the initiation of Bedaquiline from August through September 2016. In aggregate patients were similarly adherent to Bedaquiline (100%) compared to Levofloxacin (100%) and ART (98.9%) by pill count. Wisepill was more sensitive (100%) compared to seven-day recall (0%) in detecting non-adherence events (p = 0.02). Patients reported positive experiences with Wisepill and expressed willingness to use the device during a full course of DR-TB treatment. There were no concerns about stigma, confidentiality, or remote monitoring. CONCLUSION In this pilot study patients were highly adherent to Bedaquiline by all adherence measures. However, there was lower adherence to ART by pill count and Wisepill suggesting a possible challenge for adherence with ART. The use of EDM identified significantly more missed doses than seven-day recall. Wisepill was highly acceptable to DR-TB/HIV patients in South Africa, and is a promising modality to support and monitor medication adherence in complex treatment regimens.
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Affiliation(s)
- N Bionghi
- Columbia University College of Physicians and Surgeons, NY, NY, USA.,CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - A Daftary
- CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa.,McGill International TB Centre, McGill University, Montreal, Canada
| | - B Maharaj
- CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Z Msibi
- CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - K R Amico
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - C Orrell
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - N Padayatchi
- CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - M R O'Donnell
- CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa. .,Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, NY, NY, USA. .,Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, NY, NY, USA.
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7
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Mudhune V, Gvetadze R, Girde S, Ndivo R, Angira F, Zeh C, Thomas T, Lecher SL. Correlation of Adherence by Pill Count, Self-report, MEMS and Plasma Drug Levels to Treatment Response Among Women Receiving ARV Therapy for PMTCT in Kenya. AIDS Behav 2018; 22:918-928. [PMID: 28197845 DOI: 10.1007/s10461-017-1724-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Success of antiretroviral therapy depends on adherence to effective treatment. We evaluated four adherence methods and their correlation with immunological and virologic response among women receiving PMTCT. Univariable and multivariable analyses were used to assess how adherence by pill count (n = 463), self-report (n = 463), MEMS (n = 129) and plasma drug level (n = 89) was associated with viral load suppression within a 6 months period. Longitudinal analysis was performed to determine the correlation of CD4 cell count with each measure of adherence. For all measures of adherence, sustained viral suppression was less likely for participants in the lowest category of adherence. Although CD4 cell count increased substantially over time, there was no significant association with adherence by the methods. Multiple strategies can be used successfully to monitor treatment adherence. Persons with ≥95% adherence by any method used in this study were more likely to have a favorable treatment outcome.
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El Alili M, Vrijens B, Demonceau J, Evers SM, Hiligsmann M. A scoping review of studies comparing the medication event monitoring system (MEMS) with alternative methods for measuring medication adherence. Br J Clin Pharmacol 2016; 82:268-79. [PMID: 27005306 DOI: 10.1111/bcp.12942] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 12/31/2022] Open
Abstract
Different methods are available for measuring medication adherence. In this paper, we conducted a scoping review to identify and summarize evidence of all studies comparing the Medication Event Monitoring System (MEMS) with alternative methods for measuring medication adherence. A literature search was performed using the open database www.iAdherence.org that includes all original studies reporting findings from the MEMS. Papers comparing methods for measuring adherence to solid oral formulations were included. Data was extracted using a standardized extraction table. A total of 117 articles fulfilled the inclusion criteria, including 251 comparisons. Most frequent comparisons were against self-report (n = 119) and pill count (n = 59). Similar outcome measures were used in 210 comparisons (84%), among which 78 used dichotomous variables (adherent or not) and 132 used continuous measures (adherence expressed as percentage). Furthermore, 32% of all comparisons did not estimate adherence over the same coverage period and 44% of all comparisons did not use a statistical method or used a suboptimal one. Only eighty-seven (35%) comparisons had similar coverage periods, similar outcome measures and optimal statistical methods. Compared to MEMS, median adherence was grossly overestimated by 17% using self-report, by 8% using pill count and by 6% using rating. In conclusion, among all comparisons of MEMS versus alternative methods for measuring adherence, only a few used adequate comparisons in terms of outcome measures, coverage periods and statistical method. Researchers should therefore use stronger methodological frameworks when comparing measurement methods and be aware that non-electronic measures could lead to overestimation of medication adherence.
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Affiliation(s)
- Mohamed El Alili
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Bernard Vrijens
- WestRock Healthcare, Visé, Belgium.,Department of Public Health, University of Liège, Liège, Belgium
| | | | - Silvia M Evers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Trimbos Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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9
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De Boni RB, Zheng L, Rosenkranz SL, Sun X, Lavenberg J, Cardoso SW, Grinsztejn B, La Rosa A, Pierre S, Severe P, Cohn SE, Collier AC, Gross R. Binge drinking is associated with differences in weekday and weekend adherence in HIV-infected individuals. Drug Alcohol Depend 2016; 159:174-80. [PMID: 26774947 PMCID: PMC4860880 DOI: 10.1016/j.drugalcdep.2015.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 12/07/2015] [Accepted: 12/16/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Understanding patterns of antiretroviral adherence and its predictors is important for designing tailored interventions. Alcohol use is associated with non-adherence. This study aimed to evaluate: (1) if there was a difference in weekday compared with weekend adherence in HIV-infected individuals from low and middle income countries (LMIC), and (2) whether binge drinking was associated with this difference. METHODS Data from a randomized trial conducted at 9 sites in 8 LMIC were analyzed. Microelectronic monitors were used to measure adherence. Differences between weekday and weekend adherence in each quarter (successive 12-week periods) were compared using Wilcoxon signed rank tests and predictors of adherence, including baseline binge drinking, were evaluated using Generalized Estimating Equations. RESULTS Data from 255 participants were analyzed: 49.8% were male, median age was 37 years and 28.6% enrolled in Haiti. At study entry, only 2.7% reported illicit substance use, but 22.3% reported binge drinking at least once in the 30 days prior to enrollment. Adherence was higher on weekdays than weekends (median percent doses taken: 96.0% vs 94.4%; 93.7% vs 91.7%; 92.6% vs 89.7% and 93.7% vs 89.7% in quarters 1-4 respectively, all p<0.001). Binge drinking at baseline and time on study were both associated with greater differences between weekday and weekend adherence. CONCLUSIONS Adherence was worse on weekends compared to weekdays: difference was small at treatment initiation, increased over time and was associated with binge drinking. Screening and new interventions to address binge drinking, a potentially modifiable behavior, may improve adherence in HIV-infected individuals in LMIC.
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Affiliation(s)
- Raquel B De Boni
- Center for Biostatistics in AIDS Research (CBAR), Harvard School of Public Health, Boston, MA, USA; Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil.
| | - Lu Zheng
- Center for Biostatistics in AIDS Research (CBAR), Harvard School of Public Health, Boston, MA, USA
| | - Susan L Rosenkranz
- Center for Biostatistics in AIDS Research (CBAR), Harvard School of Public Health, Boston, MA, USA
| | - Xin Sun
- Center for Biostatistics in AIDS Research (CBAR), Harvard School of Public Health, Boston, MA, USA
| | - Jeffrey Lavenberg
- Center for Biostatistics in AIDS Research (CBAR), Harvard School of Public Health, Boston, MA, USA
| | - Sandra W Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Samuel Pierre
- Institut National de Laboratoire et de Recherches, Centres Gheskio, Port au Prince, Haiti
| | - Patrice Severe
- Institut National de Laboratoire et de Recherches, Centres Gheskio, Port au Prince, Haiti
| | - Susan E Cohn
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ann C Collier
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Robert Gross
- Department of Medicine (Infectious Diseases) and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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10
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Gurvich EM, Kenna GA, Leggio L. Use of novel technology-based techniques to improve alcohol-related outcomes in clinical trials. Alcohol Alcohol 2013; 48:712-9. [PMID: 23955872 DOI: 10.1093/alcalc/agt134] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
With a better understanding of the biologic basis of alcohol dependence and the considerable financial burden of alcohol abuse and dependence, the number of alcohol-related clinical pharmacotherapy trials has been on the rise. Subsequently, the potential to find efficacious treatments is more promising. Unfortunately, alcohol-related trials face a number of challenges, as a result of the difficulties that arise from traditional and outdated methods to collect data and ensure medication adherence. Novel technology-based assessments, such as ecological momentary assessment, interactive voice response, transdermal sensor and medication-event monitoring system provide a prospective solution-albeit not without possible concerns-to the difficulties faced in alcohol-related clinical trials. Clinical trials are meant to define the efficacy of the treatment and to determine an effective and safe dosage. However, due to lack of adherence a drug could inappropriately or mistakenly be judged as ineffective for treating a specific disorder. The described technologies may be important tools to prevent false negatives in validating drug efficacy, to provide consistency in clinical trials and to improve available data regarding the study of pharmacotherapies for alcohol dependence.
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Affiliation(s)
- Eugenia M Gurvich
- Corresponding author: Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, NIAAA & NIDA, NIH, 10 Center Drive (10CRC/15330) MSC 1108, Room 1-5429, Bethesda, MD 20892-1108, USA.
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11
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Blackstone K, Woods SP, Weber E, Grant I, Moore DJ. Memory-based strategies for antiretroviral medication management: an evaluation of clinical predictors, adherence behavior awareness, and effectiveness. AIDS Behav 2013; 17:74-85. [PMID: 22968399 DOI: 10.1007/s10461-012-0308-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
"Forgetting" is the most commonly endorsed reason for missing an antiretroviral therapy (ART) dose, yet little is known about the prevalence, predictors, and effectiveness of the mnemonic strategies to support ART adherence. The current study assessed 28 self-reported memory-based medication strategies in 233 HIV-infected individuals with 30-day ART adherence measured via the medication event monitoring system. Participants endorsed using multiple (8.7 ± 5.6) strategies with the most common being internally-driven. More frequent strategy use was uniquely associated with affective distress, dependent daily functioning, higher non-ART pill burden, and poorer ART adherence. Individuals who used strategies frequently, but perceived them as minimally effective, had more affective, physical, and functional distress. More frequent strategy use was associated with worse ART adherence and was unrelated to perceived effectiveness. Primary reliance on internally-based mnemonic strategies may reflect a lack of awareness of adherence behaviors and may be insufficient to support optimal ART adherence in vulnerable populations.
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12
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Exploring ART intake scenes in a human rights-based intervention to improve adherence: a randomized controlled trial. AIDS Behav 2013; 17:181-92. [PMID: 22527264 PMCID: PMC3548088 DOI: 10.1007/s10461-012-0175-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To assess the effectiveness of a psychosocial individual intervention to improve adherence to ART in a Brazilian reference-center, consenting PLHIV with viral load >50 copies/ml were selected. After 4 weeks of MEMS cap use, participants were randomized into an intervention group (IG) (n = 64) or control group (CG) (n = 57). CG received usual care only. The IG participated in a human rights-based intervention approach entailing four dialogical meetings focused on medication intake scenes. Comparison between IG and CG revealed no statistically significant difference in adherence measured at weeks 8, 12, 16, 20 and 24. Viral load (VL) decreased in both groups (p < 0.0001) with no significant difference between study groups. The lower number of eligible patients than expected underpowered the study. Ongoing qualitative analysis should provide deeper understanding of the trial results. NIH Clinical Trials: NCT00716040.
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Williams AB, Amico KR, Bova C, Womack JA. A proposal for quality standards for measuring medication adherence in research. AIDS Behav 2013; 17:284-97. [PMID: 22407465 DOI: 10.1007/s10461-012-0172-7] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A decade after widespread recognition that adherence to medication regimens is key to antiretroviral effectiveness, considerable controversy remains regarding a "gold standard" for adherence measurement. Each adherence measurement approach has strengths and weaknesses and each rests on specific assumptions. The range of assumptions regarding adherence measurement and the diversity with which each approach is implemented strongly suggest that the evaluation of a particular measure outside of the context in which it was used (e.g. the study's operational protocol) may result in undeserved confidence or lack of confidence in study results. The purpose of this paper is to propose a set of best practices across commonly used measurement methods. Recommendations regarding what information should be included in published reports regarding how adherence was measured are provided to promote improvement in the quality of measurement of medication adherence in research.
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Moore DJ, Posada C, Parikh M, Arce M, Vaida F, Riggs PK, Gouaux B, Ellis RJ, Letendre SL, Grant I, Atkinson JH. HIV-infected individuals with co-occurring bipolar disorder evidence poor antiretroviral and psychiatric medication adherence. AIDS Behav 2012; 16:2257-66. [PMID: 22041931 DOI: 10.1007/s10461-011-0072-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The contribution of bipolar disorder (BD), a prevalent serious mental illness characterized by impulsivity and mood instability, to antiretroviral (ART) and psychiatric medication adherence among HIV-infected (HIV+) individuals is unknown. We examined medication adherence among 44 HIV+/BD+ persons as compared to 33 demographically- and medically-comparable HIV+/BD- persons. Classification of adherent (≥ 90%) or non-adherent (<90%) based on proportion of correctly taken doses over 30 days was determined using electronic medication monitoring devices. HIV+/BD+ persons were significantly less likely to be ART adherent (47.7%) as compared to HIV+/BD- (90.9%) persons. Within the HIV+/BD+ group, mean psychiatric medication adherence was significantly worse than ART medication adherence, although there was a significant correlation between ART and psychiatric adherence levels. Importantly, 30-day ART adherence was associated with plasma virologic response among HIV+/BD+ individuals. Given the high overlap of HIV and BD, and the observed medication adherence difficulties for these persons, specialized adherence improvement interventions are needed.
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Affiliation(s)
- David J Moore
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA.
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Badiee J, Riggs PK, Rooney AS, Vaida F, Grant I, Atkinson JH, Moore, and the HIV Neurobehavioral DJ. Approaches to identifying appropriate medication adherence assessments for HIV infected individuals with comorbid bipolar disorder. AIDS Patient Care STDS 2012; 26:388-94. [PMID: 22686169 DOI: 10.1089/apc.2011.0447] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Assessing medication adherence in already difficult-to-treat HIV-infected subpopulations presents a unique challenge. The objective of this study was to compare different approaches to assessing medication adherence: (1) electronic medication monitoring, (2) standardized self-report questionnaire, and (3) self-report visual analogue scale, and to determine whether antiretroviral therapy (ART) adherence measures differed for HIV-infected persons with bipolar disorder (HIV+ /BD+) as compared to HIV-infected persons without bipolar disorder (HIV+ /BD-). ART adherence was assessed for 74 HIV-positive participants using the Medication Event Monitoring System (MEMS), AIDS Clinical Trials Group (ACTG) adherence questionnaire, and visual analogue scale (VAS). Participants were classified as adherent or nonadherent on each measure by previously validated cutscores. Correlations and logistic regressions were used to examine associations between adherence measures and demographic and clinical variables. In the HIV+ /BD- group, significant correlations existed between each self-report measure and the MEMS. Males comprised 81% of the study population. Participants averaged 44 years of age and 13 years of education. No significant correlations were found among adherence measures in the HIV+ /BD+ group. Among participants reporting adherence on either self-report measure but classified as nonadherent based on MEMS, 94% had a diagnosis of bipolar disorder. Bipolar disorder was a significant predictor of adherence classification discordance among self-report measures. Our findings suggest that it remains difficult to assess ART adherence among HIV-positive individuals with bipolar disorder. Combined approaches of self-report and objective measures may be the best way to estimate adherence, and may provide the best basis for interventions designed to improve adherence in difficult-to-treat populations.
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Affiliation(s)
- Jayraan Badiee
- Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla, California
| | - Patricia K. Riggs
- Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla, California
| | - Alexandra S. Rooney
- Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla, California
| | - Florin Vaida
- Department of Family and Preventive Medicine, University of California, San Diego, School of Medicine, La Jolla, California
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla, California
| | - J. Hampton Atkinson
- Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla, California
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Ortego C, Huedo-Medina TB, Llorca J, Sevilla L, Santos P, Rodríguez E, Warren MR, Vejo J. Adherence to highly active antiretroviral therapy (HAART): a meta-analysis. AIDS Behav 2011; 15:1381-96. [PMID: 21468660 DOI: 10.1007/s10461-011-9942-x] [Citation(s) in RCA: 236] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This meta-analysis synthesizes eighty-four observational studies, conducted across twenty countries, to determine the mean proportion of people who reported ≥90% adherence to prescribed highly active antiretroviral therapy (HAART) and to identify the factors associated with high levels of adherence. Eight electronic databases were searched to locate all relevant studies available by January 2010, which were then coded for sample characteristics and adherence levels. The average rate of reporting ≥90% adherent HAART adherence is 62%. However, this proportion varies greatly across studies. In particular, a greater proportion of individuals maintaining ≥90% adherence to HAART is more likely in studies with higher proportions of men who have sex with men (MSM) and lower proportions of injection drug users (IDU), with participants in an earlier stage of infection, and in studies conducted in countries characterized by lower Human Development Index (HDI) scores.
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Affiliation(s)
- Carmen Ortego
- Nursing Department, University of Cantabria, Santander, Spain.
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Senkomago V, Guwatudde D, Breda M, Khoshnood K. Barriers to antiretroviral adherence in HIV-positive patients receiving free medication in Kayunga, Uganda. AIDS Care 2011; 23:1246-53. [PMID: 21939403 DOI: 10.1080/09540121.2011.564112] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Global and local efforts have been devoted to increase the supply of antiretroviral therapy (ART) in sub-Saharan Africa. Recent qualitative studies suggest that even with free ART, patients may fail to adhere to medication because of socioeconomic barriers such as transportation costs to clinics. The aim of this study was to measure adherence in a population of patients receiving free ART and to examine barriers to adherence. Adherence was measured using the pill count and self-report methods among 140 HIV-positive patients at four PEPFAR-facilitated ART clinics in Kayunga, a rural district in Uganda. Self-report was also used to examine reasons for non-adherence. Pill count adherence estimates revealed that 86.4% of the patients were adherent (≥95%) in the past six months. Self-report estimates showed that all the patients were adherent in the past six months with average adherence of 99.7%±0.6. The main reasons for non-adherence were being away from medication at dose time (29.4%) and forgetting to take pills (27.5%). Lack of access to food and transportation costs accounted for 11.7% and 7.8% of non-adherence, respectively. Patients with 100% adherence reported lack of access to food as the main challenge they had to overcome to stay adherent. Patients attending the rural clinic were significantly less adherent to ART than patients at the Kayunga district capital [OR 0.046 (0.008-0.269)]. The study revealed that the greatest patient-perceived challenge to adherence in this population is the lack of access to food; however, the immediate reasons for non-adherence were found to be forgetfulness and being away from medication at dose's time. These results suggest that interventions tackling lack of access to food are necessary, but interventions addressing forgetfulness and being away from medication at dose's time would be the most effective in enhancing adherence inpatients receiving free ART.
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Affiliation(s)
- Virginia Senkomago
- Department of Epidemiology, UNC School of Public Health, Chapel Hill, USA.
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Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS 2011; 25:825-34. [PMID: 21252632 DOI: 10.1097/qad.0b013e32834380c1] [Citation(s) in RCA: 649] [Impact Index Per Article: 49.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is limited evidence on whether growing mobile phone availability in sub-Saharan Africa can be used to promote high adherence to antiretroviral therapy (ART). This study tested the efficacy of short message service (SMS) reminders on adherence to ART among patients attending a rural clinic in Kenya. DESIGN A randomized controlled trial of four SMS reminder interventions with 48 weeks of follow-up. METHODS Four hundred and thirty-one adult patients who had initiated ART within 3 months were enrolled and randomly assigned to a control group or one of the four intervention groups. Participants in the intervention groups received SMS reminders that were either short or long and sent at a daily or weekly frequency. Adherence was measured using the medication event monitoring system. The primary outcome was whether adherence exceeded 90% during each 12-week period of analysis and the 48-week study period. The secondary outcome was whether there were treatment interruptions lasting at least 48 h. RESULTS In intention-to-treat analysis, 53% of participants receiving weekly SMS reminders achieved adherence of at least 90% during the 48 weeks of the study, compared with 40% of participants in the control group (P = 0.03). Participants in groups receiving weekly reminders were also significantly less likely to experience treatment interruptions exceeding 48 h during the 48-week follow-up period than participants in the control group (81 vs. 90%, P = 0.03). CONCLUSION These results suggest that SMS reminders may be an important tool to achieve optimal treatment response in resource-limited settings.
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Sarem S, Li J, Nekka F. Compliance descriptors: analysis and evaluation in terms of therapeutic effect. Biopharm Drug Dispos 2011; 32:76-88. [PMID: 21341277 DOI: 10.1002/bdd.739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 11/05/2010] [Accepted: 11/10/2010] [Indexed: 12/17/2022]
Abstract
The aim of this work was to evaluate the performance of various compliance parameters in order to identify those which best assess the impact of compliance on therapeutic issues. We will discuss the particularities and restrictions of these parameters by considering two criteria, namely sensitivity index and reliability, which respectively describe strength and robustness of the relationship between these parameters and compliance. Using real and virtual data, performance analysis of compliance parameters was carried out for drugs whose pharmacokinetic properties govern the time course of their actions. Within this context, it was found that the percentage of taken doses (PTD), the most widely used parameter, poorly performed in the evaluation of the therapeutic impact of compliance. On the other hand, the adjusted percentage of correct doses (PCD*) which we propose here, showed the best reliability, making it the most appropriate parameter for the comparison of different compliance patterns. The percentage of correct doses (PCD) has, in its turn, the highest sensitivity index and thus should be preferred for the assessment of changes in compliance. Hence, a perfect parameter for the evaluation of compliance impact cannot be universally identified since each parameter can have its own characteristic advantages and limitations. The methodology proposed here is general enough to be adapted for similar drug classes to evaluate their compliance descriptors.
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Affiliation(s)
- Sarem Sarem
- Faculté de Pharmacie, Université de Montréal, C.P. 6128, Succ. Centre-ville, Montréal, Québec, H3C 3J7 Canada
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Farley J, Miller E, Zamani A, Tepper V, Morris C, Oyegunle M, Lin M, Charurat M, Blattner W. Screening for hazardous alcohol use and depressive symptomatology among HIV-infected patients in Nigeria: prevalence, predictors, and association with adherence. ACTA ACUST UNITED AC 2010; 9:218-26. [PMID: 20798401 DOI: 10.1177/1545109710371133] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Scores from the Alcohol Use Disorders Identification Test (AUDIT) and the Center for Epidemiological Studies Depression Scale (CES-D) administered to both antiretroviral therapy (ART)-experienced and -naive adults in HIV care in Nigeria were evaluated for association with participant characteristics and ART adherence measured by pharmacy records. Participants included 222 ART-experienced and 177 ART-naive adults, of whom 47 (12%) had AUDIT >/=8, 29 (7%) an AUDIT >/=10, 52 (13%) a CES-D >/=16, and 25 (6%) a CES-D >/=21. An elevated AUDIT score was more frequent among ART-naive and men, while disclosure of HIV status to others was associated with lower scores. An elevated CES-D score was more frequent among ART-naive and those with lower educational level, while disclosure of HIV status and choosing to be interviewed in English rather than Hausa was associated with lower scores. An elevated CES-D score was associated with poor adherence.
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Affiliation(s)
- John Farley
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21218, USA.
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Potchoo Y, Tchamdja K, Balogou A, Pitche VP, Guissou IP, Kassang EK. Knowledge and adherence to antiretroviral therapy among adult people living with HIV/AIDS treated in the health care centers of the association "Espoir Vie Togo" in Togo, West Africa. BMC CLINICAL PHARMACOLOGY 2010; 10:11. [PMID: 20849595 PMCID: PMC2949664 DOI: 10.1186/1472-6904-10-11] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 09/17/2010] [Indexed: 11/13/2022]
Abstract
Background The efficiency of antiretroviral therapy (ART) depends on a near perfect level of patients' adherence. The level of adherence of adults HIV-infected patients treated in the HIV/AIDS health care centres of the association "Espoir Vie Togo" in Togo, West Africa is not properly documented. The aim of the present study was to examine by means of self-reports the knowledge, the adherence level and associated factors to antiretroviral therapy (ART) among these patients. Methods We conducted a cross-sectional survey among adult people living with HIV/AIDS (PLWHA) through a structured questionnaire. Results A total of 99 patients were enrolled. Among them, 55.6% knew the name of antiretroviral agents of regimens prescribed. All patients had a good knowledge of treatment schedule. The treatment regimens based on 2 NRTIs + 1 NNRTI were used in 90% of patients. The average adherence rate was 89.8% of the total doses prescribed while 62.62% of patients showed an adherence rate of 95% or above. The treated groups were similar in term of median % of medication doses taken according to PLWHA epidemiological characteristics. However, patients reported forgetting (34.9%), travel (25.6%), cost of treatment (13.9%) and side effects (11.6%) as the main factors of missing at least once a dose intake. Conclusion These results should encourage the association and all the involved actors in the HIV/AIDS's program to strengthen counseling, education and information interventions for HIV-infected patients in order to overcome the potential barriers of poor adherence.
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Affiliation(s)
- Yao Potchoo
- Faculté Mixte de Médecine et de Pharmacie, Université de Lomé, BP 1515 Lomé, Togo.
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Ruud KW, Toverud EL, Radloff S, Srinivas SC. Antiretroviral Treatment and Follow-up of HIV-Infected Patients by Health Care Providers in South African Public Primary Health Care. J Assoc Nurses AIDS Care 2010; 21:417-28. [DOI: 10.1016/j.jana.2009.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 12/09/2009] [Indexed: 11/28/2022]
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Patient retention and adherence to antiretrovirals in a large antiretroviral therapy program in Nigeria: a longitudinal analysis for risk factors. PLoS One 2010; 5:e10584. [PMID: 20485670 PMCID: PMC2868044 DOI: 10.1371/journal.pone.0010584] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 04/02/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Substantial resources and patient commitment are required to successfully scale-up antiretroviral therapy (ART) and provide appropriate HIV management in resource-limited settings. We used pharmacy refill records to evaluate risk factors for loss to follow-up (LTFU) and non-adherence to ART in a large treatment cohort in Nigeria. METHODS AND FINDINGS We reviewed clinic records of adult patients initiating ART between March 2005 and July 2006 at five health facilities. Patients were classified as LTFU if they did not return >60 days from their expected visit. Pharmacy refill rates were calculated and used to assess non-adherence. We identified risk factors associated with LTFU and non-adherence using Cox and Generalized Estimating Equation (GEE) regressions, respectively. Of 5,760 patients initiating ART, 26% were LTFU. Female gender (p < 0.001), post-secondary education (p = 0.03), and initiating treatment with zidovudine-containing (p = 0.004) or tenofovir-containing (p = 0.05) regimens were associated with decreased risk of LTFU, while patients with only primary education (p = 0.02) and those with baseline CD4 counts (cell/ml(3)) >350 and <100 were at a higher risk of LTFU compared to patients with baseline CD4 counts of 100-200. The adjusted GEE analysis showed that patients aged <35 years (p = 0.005), who traveled for >2 hours to the clinic (p = 0.03), had total ART duration of >6 months (p<0.001), and CD4 counts >200 at ART initiation were at a higher risk of non-adherence. Patients who disclosed their HIV status to spouse/family (p = 0.01) and were treated with tenofovir-containing regimens (p < or = 0.001) were more likely to be adherent. CONCLUSIONS These findings formed the basis for implementing multiple pre-treatment visit preparation that promote disclosure and active community outreaching to support retention and adherence. Expansion of treatment access points of care to communities to diminish travel time may have a positive impact on adherence.
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Rossi GCM, Pasinetti GM, Scudeller L, Tinelli C, Milano G, Bianchi PE. Monitoring adherence rates in glaucoma patients using the Travatan Dosing Aid. A 6-month study comparing patients on travoprost 0.004% and patients on travoprost 0.004%/timolol 0.5% fixed combination. Expert Opin Pharmacother 2010; 11:499-504. [PMID: 20163264 DOI: 10.1517/14656561003601994] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess adherence in glaucoma patients using the Travatan Dosing Aid (TDA); to record differences in adherence by age, sex, therapy, systemic therapies, years from diagnosis, type of therapy and intraocular pressure (IOP). RESEARCH DESIGN AND METHODS Sixth-month cohort study; fifty-six Caucasian, primary open-angle glaucoma patients on travoprost (T) or travoprost/timolol fixed combination (TTFC) monotherapy were submitted to four visits: at baseline and months 1, 3 and 6 (M1, M3, M6). Adherence was recorded with TDA and classified as 'high' if greater than 90%. Self-reported and physician-presumed adherence data were collected. Kruskall-Wallis and Fisher's exact tests were applied. RESULTS Thirty-two patients (54.2%) were treated with T. Age, sex, level of schooling, presence of systemic comorbidities, duration of current therapy and IOP were similar between T and TTFC. Seventeen subjects (30.3%) recorded high adherence at every visit, 13 (23.2%) at two visits, 26 (46.4%) otherwise. Adherence was maintained over time with a slight decrease from month 1 to month 6 without statistical differences within and between groups. Adherence was statistically influenced by age (p = 0.007) and duration of therapy (p = 0.004). CONCLUSION The typical nonadherent patient is elderly. TDA records indicate that only a minority of patients are really adherent: predictive models to screen for poor adherence are needed.
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Greenlaw SM, Yentzer BA, O'Neill JL, Balkrishnan R, Feldman SR. Assessing adherence to dermatology treatments: a review of self-report and electronic measures. Skin Res Technol 2010; 16:253-8. [DOI: 10.1111/j.1600-0846.2010.00431.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Measuring adherence to antiretroviral treatment in resource-poor settings: the feasibility of collecting routine data for key indicators. BMC Health Serv Res 2010; 10:43. [PMID: 20170479 PMCID: PMC2836318 DOI: 10.1186/1472-6963-10-43] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 02/19/2010] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND An East African survey showed that among the few health facilities that measured adherence to antiretroviral therapy, practices and definitions varied widely. We evaluated the feasibility of collecting routine data to standardize adherence measurement using a draft set of indicators. METHODS Targeting 20 facilities each in Ethiopia, Kenya, Rwanda, and Uganda, in each facility we interviewed up to 30 patients, examined 100 patient records, and interviewed staff. RESULTS In 78 facilities, we interviewed a total of 1,631 patients and reviewed 8,282 records. Difficulties in retrieving records prevented data collection in two facilities. Overall, 94.2% of patients reported perfect adherence; dispensed medicine covered 91.1% of days in a six month retrospective period; 13.7% of patients had a gap of more than 30 days in their dispensed medication; 75.8% of patients attended clinic on or before the date of their next appointment; and 87.1% of patients attended within 3 days.In each of the four countries, the facility-specific median indicators ranged from: 97%-100% for perfect self-reported adherence, 90%-95% of days covered by dispensed medicines, 2%-19% of patients with treatment gaps of 30 days or more, and 72%-91% of appointments attended on time. Individual facilities varied considerably.The percentages of days covered by dispensed medicine, patients with more than 95% of days covered, and patients with a gap of 30 days or more were all significantly correlated with the percentages of patients who attended their appointments on time, within 3 days, or within 30 days of their appointment. Self reported recent adherence in exit interviews was significantly correlated only with the percentage of patients who attended within 3 days of their appointment. CONCLUSIONS Field tests showed that data to measure adherence can be collected systematically from health facilities in resource-poor settings. The clinical validity of these indicators is assessed in a companion article. Most patients and facilities showed high levels of adherence; however, poor levels of performance in some facilities provide a target for quality improvement efforts.
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Applebaum AJ, Reilly LC, Gonzalez JS, Richardson MA, Leveroni CL, Safren SA. The impact of neuropsychological functioning on adherence to HAART in HIV-infected substance abuse patients. AIDS Patient Care STDS 2009; 23:455-62. [PMID: 19519229 DOI: 10.1089/apc.2008.0181] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study assessed the frequency of neuropsychological impairment and its relationship to adherence in a sample of HIV-infected injection drug users (IDUs) in treatment. One hundred eight participants recruited between September 2006 and October 2008 completed psychodiagnostic and neuropsychological assessments and monitored HAART adherence over a 2-week period via the use of Medication Event Monitoring System (MEMS) electronic pill caps and self-report. Assessment of concurrent functioning included clinician-rated scales of depression and substance use severity, and a battery of neuropsychological tests. Findings from individual neuropsychological tests were converted to Z scores relative to standard norms and averaged to form a composite score (NPZ). NPZ was generally poor (mean = -1.505, standard deviation = 1.120), with 76.9% of the sample being classified as highly impaired. Self-reported adherence was significantly higher than MEMS cap adherence. In contrast with previous studies, overall neuropsychological functioning was not a significant predictor of electronically monitored or self-reported adherence. However, examiner-rated current global severity of substance use and delayed word list recall emerged as significant predictors of self-reported adherence. Additionally, estimated premorbid verbal intelligence emerged as a significant predictor of the discrepancy between electronically monitored and self-reported adherence. Given the extent of neuropsychological impairment in this sample, future studies should examine the degree to which the impact of neuropsychological impairment may moderate interventions for this population, and the extent to which skills to cope with neuropsychological problems may boost the potential efficacy of such interventions.
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Affiliation(s)
- Allison J. Applebaum
- Behavioral Medicine Services, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychology, Boston University, Boston, Massachusetts
| | - Laura C. Reilly
- Behavioral Medicine Services, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffrey S. Gonzalez
- Behavioral Medicine Services, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Yeshiva University, Bronx, New York
| | - Mark A. Richardson
- Department of Psychology, Boston University, Boston, Massachusetts
- Division of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Catherine L. Leveroni
- Behavioral Medicine Services, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Steven A. Safren
- Behavioral Medicine Services, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Okeke CO, Quigley HA, Jampel HD, Ying GS, Plyler RJ, Jiang Y, Friedman DS. Adherence with topical glaucoma medication monitored electronically the Travatan Dosing Aid study. Ophthalmology 2008; 116:191-9. [PMID: 19084273 DOI: 10.1016/j.ophtha.2008.09.004] [Citation(s) in RCA: 220] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 08/27/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To assess patient adherence and behaviors with topical once-daily therapy for glaucoma. DESIGN Prospective, observational cohort study. PARTICIPANTS One hundred ninety-six patients with glaucoma who were being treated with a prostaglandin analog in 1 or both eyes at the Scheie or Wilmer Eye Institutes between August 2006 and June 2007. METHODS Detailed medical history was obtained from each patient. All subjects used the Travatan Dosing Aid (DA; Alcon, Fort Worth, TX) to administer travoprost as prescribed. Devices were collected at 3 months and the data of drop usage was downloaded using software provided with the dosing aid. Data were analyzed for the 8-week period starting 2 weeks after the enrollment visit and ending 2 weeks before the 3-month visit. MAIN OUTCOME MEASURES Assessment of adherence and patterns of drop usage as indicated by the DA. RESULTS A total of 282 subjects consented to be in the study and 86 (30%) withdrew before study completion or had device errors, leaving 196 subjects (70%) with evaluable data at 3 months. The overall mean (+/-standard deviation) adherence rate was 0.71 (+/-0.24), ranging from 0.02 to 0.97. One hundred nine of these patients (55.6%) took greater than 75% of the expected doses. Those with adherence of less than 50% of expected doses showed substantially increased dose taking immediately after the office visit and just before the return visit at 3 months (P = 0.03). The mean adherence rate estimates of the physician and patient self-report were 0.77 and 0.95, respectively. The agreement between the physician assessment and DA-recorded adherence rate showed poor correlation for individual cases (intraclass correlation coefficient, 0.09; 95% confidence interval, 0.00-0.19). CONCLUSIONS Nearly 45% of patients using an electronic monitoring device who knew they were being monitored and were provided free medication used their drops less than 75% of the time. Patients reported far higher medication use than their actual behavior. The ability of the physician to identify which persons are poorly adherent from their self-report or from other subjective clues is poor. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Constance O Okeke
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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Watson-Jones D, Weiss HA, Rusizoka M, Changalucha J, Baisley K, Mugeye K, Tanton C, Ross D, Everett D, Clayton T, Balira R, Knight L, Hambleton I, Le Goff J, Belec L, Hayes R. Effect of herpes simplex suppression on incidence of HIV among women in Tanzania. N Engl J Med 2008; 358:1560-71. [PMID: 18337596 PMCID: PMC2643126 DOI: 10.1056/nejmoa0800260] [Citation(s) in RCA: 293] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Infection with herpes simplex virus type 2 (HSV-2) is associated with an increased risk of acquiring infection with the human immunodeficiency virus (HIV). This study tested the hypothesis that HSV-2 suppressive therapy reduces the risk of HIV acquisition. METHODS Female workers at recreational facilities in northwestern Tanzania who were 16 to 35 years of age were interviewed and underwent serologic testing for HIV and HSV-2. We enrolled female workers who were HIV-seronegative and HSV-2-seropositive in a randomized, double-blind, placebo-controlled trial of suppressive treatment with acyclovir (400 mg twice daily). Participants attended mobile clinics every 3 months for a follow-up period of 12 to 30 months, depending on enrollment date. The primary outcome was the incidence of infection with HIV. We used a modified intention-to-treat analysis; data for participants who became pregnant were censored. Adherence to treatment was estimated by a tablet count at each visit. RESULTS A total of 821 participants were randomly assigned to receive acyclovir (400 participants) or placebo (421 participants); 679 (83%) completed follow-up. Mean follow-up for the acyclovir and placebo groups was 1.52 and 1.62 years, respectively. The incidence of HIV infection was 4.27 per 100 person-years (27 participants in the acyclovir group and 28 in the placebo group), and there was no overall effect of acyclovir on the incidence of HIV (rate ratio for the acyclovir group, 1.08; 95% confidence interval, 0.64 to 1.83). The estimated median adherence was 90%. Genital HSV was detected in a similar proportion of participants in the two study groups at 6, 12, and 24 months. No serious adverse events were attributable to treatment with acyclovir. CONCLUSIONS These data show no evidence that acyclovir (400 mg twice daily) as HSV suppressive therapy decreases the incidence of infection with HIV. (Current Controlled Trials number, ISRCTN35385041 [controlled-trials.com].).
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