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Izudi J, Okoboi S, Lwevola P, Kadengye D, Bajunirwe F. Effect of disclosure of HIV status on patient representation and adherence to clinic visits in eastern Uganda: A propensity-score matched analysis. PLoS One 2021; 16:e0258745. [PMID: 34665842 PMCID: PMC8525739 DOI: 10.1371/journal.pone.0258745] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Disclosure of human immunodeficiency virus (HIV) status improves adherence to antiretroviral therapy (ART) and increases the chance of virological suppression and retention in care. However, information on the effect of disclosure of HIV status on adherence to clinic visits and patient representation is limited. We evaluated the effects of disclosure of HIV status on adherence to clinic visits and patient representation among people living with HIV in eastern Uganda. METHODS In this quasi-randomized study, we performed a propensity-score-matched analysis on observational data collected between October 2018 and September 2019 from a large ART clinic in eastern Uganda. We matched participants with disclosed HIV status to those with undisclosed HIV status based on similar propensity scores in a 1:1 ratio using the nearest neighbor caliper matching technique. The primary outcomes were patient representation (the tendency for patients to have other people pick-up their medications) and adherence to clinic visits. We fitted a logistic regression to estimate the effects of disclosure of HIV status, reported using the odds ratio (OR) and 95% confidence interval (CI). RESULTS Of 957 participants, 500 were matched. In propensity-score matched analysis, disclosure of HIV status significantly impacts adherence to clinic visits (OR = 1.63; 95% CI, 1.13-2.36) and reduced patient representation (OR = O.49; 95% CI, 0.32-0.76). Sensitivity analysis showed robustness to unmeasured confounders (Gamma value = 2.2, p = 0.04). CONCLUSIONS Disclosure of HIV status is associated with increased adherence to clinic visits and lower representation to collect medicines at the clinic. Disclosure of HIV status should be encouraged to enhance continuity of care among people living with HIV.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
- Infectious Diseases Institute, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stephen Okoboi
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
- Infectious Diseases Institute, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Paul Lwevola
- Institute of Public Health and Management, Clarke International University, Kampala, Uganda
| | - Damazo Kadengye
- African Population and Health Research Center (APHRC), APHRC Campus, Nairobi, Kenya
| | - Francis Bajunirwe
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Low level of tuberculosis preventive therapy incompletion among people living with Human Immunodeficiency Virus in eastern Uganda: A retrospective data review. J Clin Tuberc Other Mycobact Dis 2021; 25:100269. [PMID: 34504952 PMCID: PMC8414169 DOI: 10.1016/j.jctube.2021.100269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction In most developing countries, tuberculosis (TB) is the leading cause of mortality among people living with the Human Immunodeficiency Virus (PLHIV). Uganda implements TB preventive therapy (TPT) using Isoniazid but data are limited about TPT incompletion. We, therefore, assessed the magnitude of TPT incompletion and the associated factors among PLHIV in a large rural referral health facility in rural eastern Uganda. Methods and materials We conducted a retrospective data review for PLHIV initiated on TPT between October 2018 and September 2019. The outcome variable was TPT incompletion defined as the failure to finish 6 consecutive months of Isoniazid or failure to finish 9 months of Isoniazid without stopping for more than 2 months at a time. We descriptively summarized numerical data using frequencies and percentages and compared differences in the outcome with independent variables using the Chi-square or fisher’s exact, and the Student’s t-tests. We used a generalized linear model to assess factors independently associated with TPT incompletion, reported using adjusted odds ratio (aOR) and 95% confidence interval (CI). Results We enrolled 959 participants with a mean age of 41.1 ± 13.8 years, 561 (58.5%) were females, 663 (69.1%) married, 538 (56.1) travelled 5–10 km from their place of residence to the ART clinic, 293 (30.6%) had disclosed HIV status, 362 (37.7%) had been on ART for 5–9 years, and 923 (96.2%) were on first-line ART regimen. We found 26 (2.7%) participants had incomplete TPT. Non-adherence to ART clinic visits (aOR, 2.81; 95% CI, 1.09–7.73), history of switch in ART regimen (aOR, 9.33; 95% CI, 1.19–52.39), patient representation (aOR, 4.70; 95% CI, 1.35–13.99), and one unit increase in ongoing counselling session (aOR, 0.67; 95% CI, 0.46–0.91) were associated with TPT incompletion. Conclusion We found low rates of TPT incompletion among PLHIV in rural eastern Uganda. Non-adherence to ART clinic visits, patient representation, and history of switch in ART regimen is associated with a higher likelihood of TPT incompletion while ongoing counselling is associated with a reduction in TPT incompletion. The health system should address non-adherence to ART clinic visits and patient representation, through ongoing psychosocial support.
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Meshesha HM, Nigussie ZM, Asrat A, Mulatu K. Determinants of virological failure among adults on first-line highly active antiretroviral therapy at public health facilities in Kombolcha town, Northeast, Ethiopia: a case-control study. BMJ Open 2020; 10:e036223. [PMID: 32713849 PMCID: PMC7383949 DOI: 10.1136/bmjopen-2019-036223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To identify determinants of virological failure among HIV-infected adults on first-line highly active antiretroviral therapy at public health facilities in Kombolcha town, Northeast, Ethiopia, in 2019. METHODS An unmatched case-control study was conducted from April to May 2019. About 130 cases and 259 controls were selected by simple random sampling. Data were extracted from charts of patients using a structured checklist. Multiple logistic regression analysis was performed to identify possible factors. Hosmer-Lemeshow goodness of fit test was used to check the model. Finally, independent predictor variables of virological failure were identified based on adjusted OR (AOR) with 95% CI and a p value of 0.05. RESULTS The odds of virological failure were 2.4-fold (AOR=2.44, 95% CI 1.353 to 4.411) higher in clients aged <35 years compared with older clients, fivefold (AOR=5.00, 95% CI 2.60 to 9.63) higher in clients who did not disclose their HIV status, threefold (AOR=2.99, 95% CI 1.33 to 6.73) higher in clients with poor adherence, and 7.5-fold (AOR=7.51, 95% CI 3.98 to 14.14) higher in clients who had recent CD4 count of ≤250 cells/mm3. CONCLUSION AND RECOMMENDATION This study revealed that age, marital status, occupation, disclosure status, baseline functional status, missed clinic visit, current antiretroviral therapy regimen, adherence to treatment and recent CD4 count were significantly associated with virological failure. Therefore, adherence support should be strengthened among clients. Missed clinic visits should also be reduced, as it could help clients better adhere to treatment, and therefore boost their immunity and suppress viral replication.
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Affiliation(s)
- Habtamu Mengist Meshesha
- Ethiopian Field Epidemiology Training Program, Bahir Dar University, Bahir Dar, Amhara Region, Ethiopia
| | - Zelalem Mehari Nigussie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medical and Health Sciences, Bahir Dar University, Bahir Dar, Amhara region, Ethiopia
| | - Anemaw Asrat
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medical and Health Sciences, Bahir Dar University, Bahir Dar, Amhara region, Ethiopia
| | - Kebadnew Mulatu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medical and Health Sciences, Bahir Dar University, Bahir Dar, Amhara region, Ethiopia
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Mey A, Plummer D, Dukie S, Rogers GD, O'Sullivan M, Domberelli A. Motivations and Barriers to Treatment Uptake and Adherence Among People Living with HIV in Australia: A Mixed-Methods Systematic Review. AIDS Behav 2017; 21:352-385. [PMID: 27826734 DOI: 10.1007/s10461-016-1598-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In Australia, approximately 30% of people diagnosed with HIV are not accessing treatment and 8% of those receiving treatment fail to achieve viral suppression. Barriers limiting effective care warrant further examination. This mixed-methods systematic review accessed health and social sector research databases between November and December 2015 to identify studies that explored the perspective of people living with HIV in Australia. Articles were included for analysis if they described the experiences, knowledge, attitudes and beliefs, in relation to treatment uptake and adherence, published between January 2000 and December 2015. Quality appraisal utilised the Mixed Methods Appraisal Tool Version 2011. Seventy-two studies that met the inclusion criteria were reviewed. The interplay of lack of knowledge, fear, stigma, physical, emotional and social issues were found to negatively impact treatment uptake and adherence. Strategies targeting both the individual and the wider community are needed to address these barriers.
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Affiliation(s)
- Amary Mey
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia.
| | - David Plummer
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Shailendra Dukie
- School of Pharmacy, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Gary D Rogers
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Maree O'Sullivan
- Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Amber Domberelli
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
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Deiss RG, Mesner O, Agan BK, Ganesan A, Okulicz JF, Bavaro M, Lalani T, O'Bryan TA, Bebu I, Macalino GE. Characterizing the Association Between Alcohol and HIV Virologic Failure in a Military Cohort on Antiretroviral Therapy. Alcohol Clin Exp Res 2016; 40:529-35. [PMID: 26916712 DOI: 10.1111/acer.12975] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 11/23/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND The effects of at-risk drinking on HIV infection remain controversial. We investigated the impact of self-reported alcohol consumption on surrogate markers of HIV progression among individuals initiated on highly active antiretroviral therapy (HAART). METHODS We analyzed individuals who were surveyed on alcohol use within a year of HAART initiation between 2006 and 2014. At-risk drinking was defined as consumption of at least 3 or 4 drinks/d, or 7 and 14 drinks/wk among women and men, respectively. We performed time-updated generalized estimating equation logistic regression to determine the effect of at-risk drinking on virologic failure (VF) and mixed-effects linear regression on CD4 count reconstitution, controlling for potential confounders. RESULTS Of 801 individuals initiated on HAART, 752 individuals with alcohol survey data were included in the analysis. Of these, 45% (n = 336) met criteria for at-risk drinking at HAART initiation on at least 1 survey. The rates of VF were 4.30 per 100 person-years (95% CI [2.86, 6.21]) for at-risk drinkers and 2.45 per 100 person-years (95% CI [1.57, 3.65]) for individuals without at-risk drinking. At-risk drinking was not significantly associated with VF (OR 1.73, 95% CI [0.92, 3.25]) (p = 0.087) or CD4 reconstitution (CD4 increase 11.4; 95% CI [-19.8, 42.7]) in univariate analyses; however, in our multivariate model, a statistically significant relationship between VF and at-risk drinking was observed (OR 2.28, 95% CI [ 1.01, 5.15]). CONCLUSIONS We found a high proportion of at-risk drinking in our military cohort, which was predictive of VF in multivariate analysis. Given alcohol's effect on myriad HIV and non-HIV outcomes, interventions to decrease the prevalence of at-risk drinking among HIV-infected individuals are warranted.
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Affiliation(s)
- Robert G Deiss
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Division of Infectious Diseases, Naval Medical Center of San Diego, San Diego, California.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Octavio Mesner
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.,Division of Infectious Diseases, Walter Reed Medical Center, Bethesda, Maryland
| | - Jason F Okulicz
- Infectious Disease Service, San Antonio Military Medical Center, San Antonio, Texas
| | - Mary Bavaro
- Division of Infectious Diseases, Naval Medical Center of San Diego, San Diego, California
| | - Tahaniyat Lalani
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.,Division of Infectious Diseases, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Thomas A O'Bryan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.,Infectious Disease Service, San Antonio Military Medical Center, San Antonio, Texas
| | - Ionut Bebu
- Biostatistics Center, Department of Epidemiology and Biostatistics, The George Washington University, Washington, District of Columbia
| | - Grace E Macalino
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
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Park LS, Hernández-Ramírez RU, Silverberg MJ, Crothers K, Dubrow R. Prevalence of non-HIV cancer risk factors in persons living with HIV/AIDS: a meta-analysis. AIDS 2016; 30:273-91. [PMID: 26691548 PMCID: PMC4689318 DOI: 10.1097/qad.0000000000000922] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The burden of cancer among persons living with HIV/AIDS (PLWHA) is substantial and increasing. We assessed the prevalence of modifiable cancer risk factors among adult PLWHA in Western high-income countries since 2000. DESIGN Meta-analysis. METHODS We searched PubMed to identify articles published in 2011-2013 reporting prevalence of smoking, alcohol consumption, overweight/obesity, and infection with human papillomavirus (HPV), hepatitis C virus (HCV) and hepatitis B virus (HBV) among PLWHA. We conducted random effects meta-analyses of prevalence for each risk factor, including estimation of overall, sex-specific, and HIV-transmission-group-specific prevalence. We compared prevalence in PLWHA with published prevalence estimates in US adults. RESULTS The meta-analysis included 113 publications. Overall summary prevalence estimates were current smoking, 54% [95% confidence interval (CI) 49-59%] versus 20-23% in US adults; cervical high-risk HPV infection, 46% (95% CI 34-58%) versus 29% in US females; oral high-risk HPV infection, 16% (95% CI 10-23%) versus 4% in US adults; anal high-risk HPV infection (men who have sex with men), 68% (95% CI 57-79%), with no comparison estimate available; chronic HCV infection, 26% (95% CI 21-30%) versus 0.9% in US adults; and HBV infection, 5% (95% CI 4-5%) versus 0.3% in US adults. Overweight/obesity prevalence (53%; 95% CI 46-59%) was below that of US adults (68%). Meta-analysis of alcohol consumption prevalence was impeded by varying assessment methods. Overall, we observed considerable study heterogeneity in prevalence estimates. CONCLUSION Prevalence of smoking and oncogenic virus infections continues to be extraordinarily high among PLWHA, indicating a vital need for risk factor reduction efforts.
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Affiliation(s)
- Lesley S Park
- aDivision of Endocrinology, Gerontology, and Metabolism, Department of Medicine and Division of Epidemiology, Department of Health Policy and Research, Stanford University School of Medicine, Stanford, CaliforniabDepartment of Chronic Disease Epidemiology, Yale School of Public Health, Yale School of Medicine, New Haven, ConnecticutcDivision of Research, Kaiser Permanente, Oakland, CaliforniadDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington, USA.*Lesley S. Park and Raúl U. Hernández-Ramírez contributed equally to this article
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Kimeu M, Burmen B, Audi B, Adega A, Owuor K, Arodi S, Bii D, Zielinski-Gutiérrez E. The relationship between adherence to clinic appointments and year-one mortality for newly enrolled HIV infected patients at a regional referral hospital in Western Kenya, January 2011-December 2012. AIDS Care 2015; 28:409-15. [PMID: 26572059 DOI: 10.1080/09540121.2015.1109587] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This retrospective cohort analysis was conducted to describe the association between adherence to clinic appointments and mortality, one year after enrollment into HIV care. We examined appointment-adherence for newly enrolled patients between January 2011 and December 2012 at a regional referral hospital in western Kenya. The outcomes of interest were patient default, risk factors for repeat default, and year-one risk of death. Of 582 enrolled patients, 258 (44%) were defaulters. GEE revealed that once having been defaulters, patients were significantly more likely to repeatedly default (OR 1.4; 95% CI 1.12-1.77), especially the unemployed (OR 1.43; 95% CI 1.07-1.91), smokers (OR 2.22; 95% CI 1.31-3.76), and those with no known disclosure (OR 2.17; 95% CI 1.42-3.3). Nineteen patients (3%) died during the follow-up period. Cox proportional hazards revealed that the risk of death was significantly higher among defaulters (HR 3.12; 95% CI 1.2-8.0) and increased proportionally to the rate of patient default; HR was 4.05 (95% CI1.38-11.81) and 4.98 (95% CI 1.45-17.09) for a cumulative of 4-60 and ≥60 days elapsed between all scheduled and actual clinic appointment dates, respectively. Risk factors for repeat default suggest a need to deliver targeted adherence programs.
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Affiliation(s)
- Muthusi Kimeu
- a Global Programs for Research and Training , University of California , San Francisco , Nairobi , Kenya
| | - Barbara Burmen
- b HIV Implementation Science and Services Kenya Medical Research Institute/Centers for Global Health Research (KEMRI,CGHR) , Kisumu , Kenya
| | - Beryl Audi
- b HIV Implementation Science and Services Kenya Medical Research Institute/Centers for Global Health Research (KEMRI,CGHR) , Kisumu , Kenya
| | - Anne Adega
- b HIV Implementation Science and Services Kenya Medical Research Institute/Centers for Global Health Research (KEMRI,CGHR) , Kisumu , Kenya
| | - Karen Owuor
- b HIV Implementation Science and Services Kenya Medical Research Institute/Centers for Global Health Research (KEMRI,CGHR) , Kisumu , Kenya
| | - Susan Arodi
- c HIV Comprehensive Care Centre , Jaramogi Oginga Odinga Teaching and Referral Hospital , Kisumu , Kenya
| | - Dennis Bii
- b HIV Implementation Science and Services Kenya Medical Research Institute/Centers for Global Health Research (KEMRI,CGHR) , Kisumu , Kenya
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Abah IO, Darin KM, Ebonyi AO, Ugoagwu P, Ojeh VB, Nasir N, Falang KD, Olaitan O, Agbaji O, Idoko J, Kanki P. Patterns and Predictors of First-Line Antiretroviral Therapy Modification in HIV-1-Infected Adults in a Large Urban Outpatient Cohort in Nigeria. J Int Assoc Provid AIDS Care 2015; 14:348-54. [PMID: 25566781 DOI: 10.1177/2325957414565508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We described the magnitude, type, and factors associated with first-line antiretroviral therapy (ART) modification in HIV-1-infected adults on ART in Jos, Nigeria. METHOD Data on 6309 patients initiated on first-line ART between January 2004 and December 2006 were analyzed retrospectively. Factors predictive of modification to initial ART were assessed by chi-square and multivariable logistic regression analysis. RESULTS Overall, 5212 (83%) included patients incurred a modification (73.3% drug substitution and 9.7% drug switch) to their initial first-line ARV regimen during a median (interquartile range) follow-up period of 7 (3-8) years. Drug substitutions of zidovudine (ZDV) were less likely than of tenofovir (TDF; adjusted odd ratio [AOR] 0.6; 95% confidence interval [CI]: 0.51-0.71), and Drug substitutions of efavirenz (EFV) were more likely than of nevirapine (NVP)-containing (AOR 1.82; 95% CI: 1.42-2.33) regimens. Predictors of switch to second-line regimen include older age (AOR 2.05; 95% CI: 1.68-2.51), CD4 count≤100 cells/mm3 (AOR 1.89; 95% CI: 1.49-2.37), EFV compared to NVP (AOR 1.38; 95% CI: 1.02-1.88), and drug toxicity (AOR 1.90; 95% CI: 1.48-2.43). CONCLUSION Modification to initial ART was common in this study. Further evaluation of the contribution of guideline changes on regimen modification and treatment outcomes is recommended.
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Affiliation(s)
| | - Kristin M Darin
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | | | | | - Naima Nasir
- Jos University Teaching Hospital, Jos, Nigeria
| | | | - Oluremi Olaitan
- AIDS Prevention Initiative in Nigeria, Ltd./Gte, Lagos, Nigeria
| | - Oche Agbaji
- University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - John Idoko
- National Agency for the Control of AIDS (NACA), Abuja, Nigeria
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Tontodonati M, Cenderello G, Celesia BM, Trezzi M, Ursini T, Costantini A, Marra D, Polilli E, Catalani C, Butini L, Sozio F, Mazzotta E, Sciacca A, Rizzardini G, Manzoli L, Cozzi-Lepri A, Parruti G. Cost of HAART in Italy: multicentric evaluation and determinants from a large HIV outpatient cohort. CLINICOECONOMICS AND OUTCOMES RESEARCH 2014; 7:27-35. [PMID: 25565872 PMCID: PMC4278727 DOI: 10.2147/ceor.s69183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background As HIV infection turned into a chronic treatable disease, now ranking as one of the most costly in medicine, long-term sustainability of highly active antiretroviral treatment (HAART) expenses became a major issue, especially in countries with universal access to care. Identification of determinants of higher HAART costs may therefore help in controlling costs of care, while keeping high levels of retention in care and viral suppression. Methods With this aim, we enrolled a large multicentric sample of consecutive unselected human immunodeficiency virus (HIV) patients followed at five sites of care in Italy, and evaluated annual individual HAART costs in relation to a number of sociodemographic, clinical, and laboratory variables. Results We enrolled 2,044 patients, including 1,902 on HAART. Mean HAART costs were €9,377±€3,501 (range 782–29,852) per year, with remarkable site-based differences, possibly related to the different composition of local assisted populations. Percentages of patients on viral suppression were homogeneously high across all study sites. The factors identified by cross-validation were line of HAART, diagnosis of acquired immune deficiency syndrome, current CD4 T-cell count, and detectable HIV viremia >50 copies/mL. In the final multivariable model, HAART costs were independently directly associated with more advanced HAART line (P<0.001) and inversely correlated with current CD4 T-cell count (P=0.024). Site of care held independent prediction of higher costs, with marked control of expenses at sites 2 (P=0.001) and 5 (P<0.001). Conclusion Higher costs of HAART were strongly associated with previous treatment failures, detectable HIV viremia, and lower CD4 T-cell count at the time of evaluation, with no correlation at all with sex, age, hepatitis C virus coinfection, and nadir CD4 T-cell counts. Newer drugs, which are typically those associated with high prices, at the time of the analysis were still prevalently prescribed to rescue and maintain viral suppression in patients with more complex treatment history. Further analyses of the contribution of the single drug/regimen to the estimated cost are warranted.
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Affiliation(s)
- Monica Tontodonati
- Infectious Disease Unit, Pescara General Hospital, Pescara, Italy ; Clinic of Infectious Diseases, G D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | | | | | - Michele Trezzi
- Infectious Diseases Unit, Pistoia General Hospital, Pistoia, Italy
| | - Tamara Ursini
- Clinic of Infectious Diseases, G D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | | | - Domenico Marra
- Division of Oncology, Galliera General Hospital, Genoa, Italy
| | - Ennio Polilli
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Corrado Catalani
- Infectious Diseases Unit, Pistoia General Hospital, Pistoia, Italy
| | - Luca Butini
- Clinical Immunology Unit, Ancona Hospital, Ancona, Italy
| | - Federica Sozio
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Elena Mazzotta
- Internal Medicine Department, G D'Annunzio University of Chieti-Pescara, Chieti
| | - Antonina Sciacca
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | | | - Lamberto Manzoli
- Section of Hygiene, Epidemiology, Pharmacology and Legal Medicine, G D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Alessandro Cozzi-Lepri
- Research Department of Infection and Population Health, University College London, London, UK
| | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
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Patel DA, Snedecor SJ, Tang WY, Sudharshan L, Lim JW, Cuffe R, Pulgar S, Gilchrist KA, Camejo RR, Stephens J, Nichols G. 48-week efficacy and safety of dolutegravir relative to commonly used third agents in treatment-naive HIV-1-infected patients: a systematic review and network meta-analysis. PLoS One 2014; 9:e105653. [PMID: 25188312 PMCID: PMC4154896 DOI: 10.1371/journal.pone.0105653] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/22/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A network meta-analysis can provide estimates of relative efficacy for treatments not directly studied in head-to-head randomized controlled trials. We estimated the relative efficacy and safety of dolutegravir (DTG) versus third agents currently recommended by guidelines, including ritonavir-boosted atazanavir (ATV/r), ritonavir-boosted darunavir (DRV/r), efavirenz (EFV), cobicistat-boosted elvitegravir (EVG/c), ritonavir-boosted lopinavir (LPV/r), raltegravir (RAL), and rilpivirine (RPV), in treatment-naive HIV-1-infected patients. METHODS A systematic review of published literature was conducted to identify phase 3/4 randomized controlled clinical trials (up to August 2013) including at least one third agent of interest in combination with a backbone nucleoside reverse transcriptase inhibitor (NRTI) regimen. Bayesian fixed-effect network meta-analysis models adjusting for the type of nucleoside reverse transcriptase inhibitor backbone (tenofovir disoproxil fumarate/emtricitabine [TDF/FTC] or abacavir/lamivudine [ABC/3TC]) were used to evaluate week 48 efficacy (HIV-RNA suppression to <50 copies/mL and change in CD4+ cells/µL) and safety (lipid changes, adverse events, and discontinuations due to adverse events) of DTG relative to all other treatments. Sensitivity analyses assessing the impact of NRTI treatment adjustment and random-effects models were performed. RESULTS Thirty-one studies including 17,000 patients were combined in the analysis. Adjusting for the effect of NRTI backbone, treatment with DTG resulted in significantly higher odds of virologic suppression (HIV RNA<50 copies/mL) and increase in CD4+ cells/µL versus ATV/r, DRV/r, EFV, LPV/r, and RPV. Dolutegravir had better or equivalent changes in total cholesterol, LDL, triglycerides, and lower odds of adverse events and discontinuation due to adverse events compared to all treatments. Random-effects and unadjusted models resulted in similar conclusions. CONCLUSION Three clinical trials of DTG have demonstrated comparable or superior efficacy and safety to DRV, RAL, and EFV in HIV-1-infected treatment-naive patients. This network meta-analysis suggests DTG is also favorable or comparable to other commonly used third agents (ATV/r, LPV/r, RPV, and EVG/c).
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Affiliation(s)
- Dipen A. Patel
- Pharmerit International, Bethesda, Maryland, United States of America
| | - Sonya J. Snedecor
- Pharmerit International, Bethesda, Maryland, United States of America
| | - Wing Yu Tang
- Pharmerit International, Bethesda, Maryland, United States of America
| | | | | | | | - Sonia Pulgar
- GlaxoSmithKline, Research Triangle Park, North Carolina, United States of America
| | - Kim A. Gilchrist
- GlaxoSmithKline, Renaissance, Pennsylvania, United States of America
| | | | - Jennifer Stephens
- Pharmerit International, Bethesda, Maryland, United States of America
| | - Garrett Nichols
- GlaxoSmithKline, Research Triangle Park, North Carolina, United States of America
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Figueroa MI, Sued O, Cahn P. What to do Next? Second-line Antiretroviral Therapy. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2014. [DOI: 10.1007/s40506-014-0013-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Solem CT, Snedecor SJ, Khachatryan A, Nedrow K, Tawadrous M, Chambers R, Haider S, Simpson K. Cost of treatment in a US commercially insured, HIV-1-infected population. PLoS One 2014; 9:e98152. [PMID: 24866200 PMCID: PMC4035292 DOI: 10.1371/journal.pone.0098152] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 04/29/2014] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Recent treatment patterns and cost data associated with HIV in the United States are limited. This study assessed first-line persistence and healthcare costs of HIV-1 in patients by treatment line and CD4 cell count. METHODS MarketScan Commercial Claims and Encounters Database (2007-2011) and Lab Database (2007-2010) were used to construct two HIV-1 cohorts: 1) newly treated HIV-1-infected patients with ≥6 months' continuous enrollment prior to first third-agent drug claim (Newly Treated Cohort) and 2) CD4 cell count test results (CD4 Measurements Cohort). All patients were ≥18 years old and without hepatitis co-infection. The Kaplan-Meier method was used to measure treatment switch rates. Generalized linear models (gamma distribution, log link) were used to compare healthcare costs by treatment line and CD4 cell count controlling for potential confounders. RESULTS Newly treated patients (n = 8,617) had mean age of 41, 82% were male, and 20% had experienced AIDS-defining events at baseline. Over 20% of newly treated patients switched initial treatment regimen within 2 years. Average unadjusted (and covariate-adjusted) total healthcare cost/year was $33,674 ($28,861) for first-line, $39,191 ($35,805) for second-line, and $39,882 ($40,804) for third-line treatment. Covariate-adjusted costs of care on second- and third-line treatments were significantly more expensive than first-line treatment (24% [p<0.001] and 41% [p = 0.006] higher, respectively). The CD4 Measurements Cohort included 803 CD4 measurements (mean age 49, 76% male, 8% experienced an AIDS-defining event). Costs associated with CD4 measurements <100 cells/µL were 92% higher than those with >350 cells/µL (p<0.001). For higher CD4 cell counts, the majority of expenditures were for antiretrovirals (64% of total for CD4 >350 cells/µL). CONCLUSIONS Despite modern advances in antiretroviral therapy and medical care, direct medical costs of HIV-1-infected patients increase after treatment switch and with lower CD4 counts, consistent with previous costing studies.
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Affiliation(s)
- Caitlyn T. Solem
- Pharmerit International, Bethesda, Maryland, United States of America
| | - Sonya J. Snedecor
- Pharmerit International, Bethesda, Maryland, United States of America
| | | | | | | | - Richard Chambers
- Pfizer Inc, Collegeville, Philadelphia, United States of America
| | - Seema Haider
- Pfizer Inc, Groton, Connecticut, United States of America
| | - Kit Simpson
- Medical University of South Carolina, Charleston, South Carolina, United States of America
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