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Lacombe K, Moh R, Chazallon C, Lemoine M, Sylla B, Fadiga F, Le Carrou J, Marcellin F, Kouanfack C, Ciaffi L, Sartre MT, Sida MB, Diallo A, Gozlan J, Seydi M, Cissé V, Danel C, Girard PM, Toni TD, Minga A, Boyer S, Carrieri P, Attia A. Feasibility, safety, efficacy and potential scaling-up of sofosbuvir-based HCV treatment in Central and West Africa: (TAC ANRS 12311 trial). Sci Rep 2024; 14:10244. [PMID: 38702350 PMCID: PMC11068860 DOI: 10.1038/s41598-024-57013-1] [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: 11/08/2023] [Accepted: 03/13/2024] [Indexed: 05/06/2024] Open
Abstract
Access to Hepatis C treatment in Sub-Saharan Africa is a clinical, public health and ethical concern. The multi-country open-label trial TAC ANRS 12311 allowed assessing the feasibility, safety, efficacy of a specific care model of HCV treatment and retreatment in patients with hepatitis C in Sub Saharan Africa. Between November 2015 and March 2017, with follow-up until mid 2019, treatment-naïve patients with HCV without decompensated cirrhosis or liver cancer were recruited to receive 12 week-treatment with either sofosbuvir + ribavirin (HCV genotype 2) or sofosbuvir + ledipasvir (genotype 1 or 4) and retreatment with sofosbuvir + velpatasvir + voxilaprevir in case of virological failure. The primary outcome was sustained virological response at 12 weeks after end of treatment (SVR12). Secondary outcomes included treatment adherence, safety and SVR12 in patients who were retreated due to non-response to first-line treatment. The model of care relied on both viral load assessment and educational sessions to increase patient awareness, adherence and health literacy. The study recruited 120 participants, 36 HIV-co-infected, and 14 cirrhotic. Only one patient discontinued treatment because of return to home country. Neither death nor severe adverse event occurred. SVR12 was reached in 107 patients (89%): (90%) in genotype 1 or 2, and 88% in GT-4. All retreated patients (n = 13) reached SVR12. HCV treatment is highly acceptable, safe and effective under this model of care. Implementation research is now needed to scale up point-of-care HCV testing and SVR assessment, along with community involvement in patient education, to achieve HCV elimination in Sub-Saharan Africa.
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Affiliation(s)
- Karine Lacombe
- Infectious Diseases Department, Inserm IPLESP, UMR-S1136, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France.
- Service des Maladies Infectieuses et Tropicales, Hôpital St Antoine, 184 rue du Fbg St Antoine, 75012, Paris, France.
| | - Raoul Moh
- Unité Pédagogique de Dermatologie et Infectiologie, Université Félix Houphouet-Boigny, Abidjan, Côte d'Ivoire
- Programme PAC-CI, Site ANRS de Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Corine Chazallon
- National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, University of Bordeaux, Bordeaux, France
| | - Maud Lemoine
- Hepatology Unit, Digestive Disease Division, Imperial College London, St Mary's Hospital, London, UK
| | - Babacar Sylla
- IMEA, Hôpital Bichat - Claude Bernard, Paris, France
| | - Fatoumata Fadiga
- Programme PAC-CI, Site ANRS de Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Jerôme Le Carrou
- National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, University of Bordeaux, Bordeaux, France
| | - Fabienne Marcellin
- Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Aix Marseille Univ, Marseille, France
| | | | - Laura Ciaffi
- TransVIHMI - IRD UMI233 - INSERM U1175, Université de Montpellier, Montpellier, France
| | | | - Magloire Biwole Sida
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé 1, Yaoundé, Cameroon
| | - Alpha Diallo
- Service de Pharmacovigilance, ANRS, Paris, France
| | - Joel Gozlan
- Department of Virology, INSERM, UMR_S 938, Centre de Recherche Saint-Antoine, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Moussa Seydi
- Service des Maladies Infectieuses et Tropicales, CHNU de Fann, Dakar, Senegal
| | - Viviane Cissé
- Service des Maladies Infectieuses et Tropicales, Centre Régional de Recherche et de Formation, Site ANRS, CHNU de Fann, Dakar, Senegal
| | | | - Pierre Marie Girard
- Infectious Diseases Department, Inserm IPLESP, UMR-S1136, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Thomas d'Aquin Toni
- Service de Virologie, Centre de diagnostic et de recherche sur le SIDA, CHU Treichville, Abidjan, Côte d'Ivoire
| | - Albert Minga
- Centre National des Donneurs de Sang, Abidjan, Côte d'Ivoire
| | - Sylvie Boyer
- Hôpital de Jour, Hôpital Central, Yaoundé, Cameroon
| | | | - Alain Attia
- Service d'hépatologie, CHU de Yopougon, Abidjan, Côte d'Ivoire
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Lindh M, Brännström J, Reepalu A, Svedhem V, Mellgren Å. Factors associated with sex differences in viral non-suppression in the Swedish InfCareHIV cohort: An observational real-world study. HIV Med 2024; 25:540-553. [PMID: 38196293 DOI: 10.1111/hiv.13607] [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: 09/15/2023] [Accepted: 12/16/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES Women living with HIV are underrepresented in clinical trials assessing outcomes of antiretroviral treatment (ART), justifying the need for observational studies. We investigated differences in viral non-suppression between women and men in the Swedish InfCareHIV cohort and analysed results in relation to biological and socio-demographic variables and patient-reported outcome measures (PROMs). METHODS The study included people living with HIV (PLWH) aged ≥18 years, who initiated ART at least 6 months prior to inclusion. Data from the InfCareHIV registry 2011-2018 were collected. Associations between variables and HIV RNA ≥50 copies/mL were investigated in uni- and multivariable analyses using generalized estimating equations, providing relative risks (RRs) as effect size. RESULTS The study included 38% (n = 2981) women. Women were more likely to have HIV RNA ≥50 copies/mL than were men [RR = 1.20, 95% confidence interval (CI): 1.10-1.31]. After adjusting for origin and route of transmission, sex at birth was no longer associated with viral non-suppression. PROMs were available in 52.4% of PLWH, and items associated with viral non-suppression were impaired adherence in women (RR = 2.38, 95% CI: 1.79-3.17) and men (RR 1.84, 95% CI: 1.40-2.42), and experience of side effects in women (RR = 1.49, 95% CI: 1.10-2.02). CONCLUSIONS This observational study found a 20% higher relative risk of viral non-suppression in women than in men and the difference was associated with socio-demographic factors. The associations between PROMs and viral non-suppression varied between women and men. PROMs are important health outcomes that may identify PLWH in need of support to achieve viral non-suppression.
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Affiliation(s)
- Maria Lindh
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Södra Älvsborg Hospital, Department of Research, Education and Innovation, Borås, Sweden
- Department of Infectious Diseases, Södra Älvsborg Hospital, Borås, Sweden
| | - Johanna Brännström
- Division of Infection and Dermatology, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
- Department of Infectious Diseases/Venhälsan, South Hospital, Stockholm, Sweden
| | - Anton Reepalu
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
| | - Veronica Svedhem
- Division of Infection and Dermatology, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
| | - Åsa Mellgren
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Aytenew TM, Demis S, Birhane BM, Asferie WN, Simegn A, Nibret G, Kassaw A, Asnakew S, Tesfahun Y, Andualem H, Bantie B, Kassaw G, Kefale D, Zeleke S. Non-Adherence to Anti-Retroviral Therapy Among Adult People Living with HIV in Ethiopia: Systematic Review and Meta-Analysis. AIDS Behav 2024; 28:609-624. [PMID: 38157133 PMCID: PMC10876791 DOI: 10.1007/s10461-023-04252-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
Human immunodeficiency virus remains a global public health problem. Despite efforts to determine the prevalence of non-adherence to ART and its predictors in Ethiopia, various primary studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of non-adherence to ART and identify its predictors. We have searched PubMed, Google Scholar and Web of Science databases extensively for all available studies. A weighted inverse-variance random-effects model was used to compute the overall non-adherence to ART. The pooled prevalence of non-adherence to ART was 20.68% (95% CI: 17.74, 23.61); I2 = 98.40%; p < 0.001). Educational level of primary school and lower [AOR = 3.5, 95%CI: 1.7, 7.4], taking co-medications [AOR = 0.45, 95%CI: 0.35, 0.59], not using memory aids [AOR = 0.30, 95%CI: 0.13, 0.71], depression [AOR = 2.0, 95%CI: 1.05, 3.79], comorbidity [AOR = 2.12, 95%CI: 1.16, 3.09), under-nutrition [AOR = 2.02, 95%CI: 1.20, 3.43], not believing on ART can control HIV [AOR = 2.31, 95%CI: 1.92, 2.77], lack of access to health facilities [AOR = 3.86, 95%CI: 1.10, 13.51] and taking ART pills uncomfortably while others looking [AOR = 5.21, 95%CI: 2.56, 10.53] were significantly associated with non-adherence to anti-retroviral therapy. The overall pooled prevalence of non-adherence to ART was considerably high in Ethiopia. Educational status, taking co-medications, not using memory aids, depression, comorbidity, under nutrition, not believing on anti-retroviral therapy controls HIV, lack of access to health facilities and taking ART pills uncomfortably were independent predictors of non-adherence to ART in Ethiopia. Therefore, healthcare providers, adherence counselors and supporters should detect non-adherence behaviors and patients' difficulties with ART early, and provide intensive counseling to promote adherence.
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Affiliation(s)
- Tigabu Munye Aytenew
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Solomon Demis
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Worku Necho Asferie
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Simegn
- Department of Reproductive Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gedefaye Nibret
- Department of Reproductive Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Kassaw
- Department of Pediatrics and Child health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sintayehu Asnakew
- Department of Psychiatry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yohannes Tesfahun
- Department of Emergency and Critical Care Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Henock Andualem
- Department of Medical Laboratory, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Berihun Bantie
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gebrie Kassaw
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- Department of Pediatrics and Child health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Shegaw Zeleke
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Tariku MK, Worede DT, Belete AH. Adherence to antiretroviral therapy and associated factors among human immunodeficiency -positive patients accessing treatment at health centers in East Gojjam Zone, Northwest Ethiopia, 2019: Community-based cross-sectional study. Heliyon 2023; 9:e18279. [PMID: 37501982 PMCID: PMC10368896 DOI: 10.1016/j.heliyon.2023.e18279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
Background To achieve an effective treatment outcome, Antiretroviral Therapy (ART) for people living with the Human immunodeficiency virus (HIV) needs at least a 95% adherence level. The aim was to assess adherence to antiretroviral therapy and its associated factors among patients accessing treatment at Health centers in East Gojjam Zone, Northwest Ethiopia. Methods A community-based cross-sectional study was conducted on 770 HIV-positive patients from April 1 to May 10, 2019, in East Gojjam Zone. The study participants were selected by simple random computerized sampling methods. Primary data was collected from the patients through face-to-face interviews and home-to-home visits. Bivariable and multivariable binary logistic regression analyses were done. Independent variables with a P-value of <0.2 in bivariable binary logistic regression analysis were considered for multivariable binary logistic regression analysis. A P-value of <0.05 was used as the cut-off point for the presence of statistical significance. Results About 396 (51.8%) of the study participants had good adherence. Being 18-24 years old [Adjusted Odd Ratio (AOR) = 0.43; 95% CI = 0.21-0.86], having a marital status of being widowed (AOR = 0.29; 95% CI = 0.14-0.58), having a disease duration of >10 years (AOR = 0.47; 95% CI = 0.24-0.94), taking a drug regimen of Tenofovir (TDF) + Lamivudine (3 TC) + Nevirapine (NVP) (AOR = 2.94; 95% CI = 1.406.15), not being socially stigmatized (AOR = 0.52; 95% CI = 0.34-0.78), and having not encountered an opportunistic infection (AOR = 3.91; 95% CI = 2.68-5.72) were significant factors. Conclusions The level of adherence was low. Opportunistic infection prevention, reduction of social stigma, and other intervention activities should be strengthened to increase the level of adherence.
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David IJ, Schatz E, Angotti N, Myroniuk TW, Mojola SA. "I'm Getting Life from the Treatment": Perceptions of Life and Death Among Middle-Aged and Older Medication-Adherent Persons Living with HIV in Rural South Africa. J Aging Soc Policy 2023:1-23. [PMID: 36973857 DOI: 10.1080/08959420.2023.2195348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/15/2022] [Indexed: 03/29/2023]
Abstract
The widespread availability of health information and treatment for HIV in Southern Africa does not reach all populations. Few programs and materials are developed with middle-aged and older rural individuals living with HIV as the target audience, despite this being a growing population. This vacuum inevitably exacerbates the disjuncture between clinical and experiential knowledge. This study uses in-depth interviews from 2018 with middle-aged and older rural South Africans who self-report medication adherence to ART in order to explore experiences of living with HIV and beliefs about anti-retroviral treatment (ART). Participants revealed a general sense of vulnerability as a major motivation for HIV medication adherence. A majority of the participants believed that death was imminent if they defaulted on ART at any point in time. Although the availability of ART brought hope to many, HIV was still perceived as a death sentence, particularly if ART adherence was imperfect. The study findings suggest a need to examine the psychosocial component of community programs for middle-aged and older people living with HIV. For this growing population that experienced the full course of the epidemic, more research is needed on the burden of psychological and mental health issues emerging from the need for long-term HIV medication adherence.
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Affiliation(s)
- Ifeolu J David
- Department of public health, University of Missouri, Columbia, MO, USA
| | - Enid Schatz
- Department of public health, University of Missouri, Columbia, MO, USA
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Angotti
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of sociology, American University, Washington DC, USA
| | - Tyler W Myroniuk
- Department of public health, University of Missouri, Columbia, MO, USA
| | - Sanyu A Mojola
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of sociology, Princeton University, Princeton, NJ, USA
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Short-Term Adverse Drug Reactions to Antiretroviral Therapy in Children with HIV: A Cohort Study. Indian J Pediatr 2023; 90:9-15. [PMID: 35113365 DOI: 10.1007/s12098-021-04045-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/18/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To carry out an active surveillance for adverse drug reactions (ADRs) in children with HIV infection newly initiated on antiretroviral therapy (ART), determine risk factors for their occurrence, and assess their influence on adherence to ART. METHODS All children newly initiated on ART from 1st March 2014 to 30th June 2019 at a tertiary care children's hospital in New Delhi, were actively monitored for ADRs to ART for a period of 6 mo after ART initiation. The frequency, spectrum, and severity of ADRs, their influence on adherence, and risk factors for their occurrence were analyzed. RESULTS Among the 174 enrolled children, ADRs were observed in 78 (44.8%) children during the first 6 mo after ART initiation. Total numbers of episodes of ADR observed were 108 (0.62 episodes of ADR/child). Sixty percent of events were of grade 1 severity, 19.4% events were of grade 2 and 3 each, while 1 (0.9%) event was of grade 4 severity. Adherence to ART was adversely affected in 21.8% of ADRs. Gastrointestinal symptoms (49.1%) were most frequent among all the events observed. Zidovudine, lopinavir/ritonavir, efavirenz and nevirapine based regimes were significantly associated with hematological, gastrointestinal, neurological, and dermatological ADRs, respectively. Children with immunological suppression were at a higher risk of developing ADRs as compared to those without it [RR 1.9 (95% CI (1.1-3.2)]. CONCLUSIONS ADRs to ART are very frequent; most of them are mild and self-limiting. However, they can adversely impact adherence to ART. Anticipatory guidance, ongoing monitoring, and provision of symptomatic treatment will help tide over most ADRs and reduce their adverse impact upon ART adherence.
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Wardojo SSI, Huang YL, Chuang KY. Determinants of the quality of life amongst HIV clinic attendees in Malang, Indonesia. BMC Public Health 2021; 21:1272. [PMID: 34193121 PMCID: PMC8243711 DOI: 10.1186/s12889-021-11321-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As the number of people living with human immunodeficiency virus (HIV; PLHIV) in Indonesia has increased in recent years, more efforts have been expended to improve their health status. However, in a country where PLHIV are very much stigmatized, there has been little research concerning their quality of life (QoL). Hence, this study aimed to assess the QoL among PLHIV and its associated factors. Findings of this research can contribute to improving the health and wellbeing of PLHIV in Indonesia. METHODS A cross-sectional survey with convenience sampling was conducted from June to September 2018, at four healthcare centers in Malang, Indonesia. PLHIV, aged 18 years or over, were asked if they would like to participate in this study when they came to a health center to receive services. To protect confidentiality, the healthcare staff at the clinics assisted with recruitment and face-to-face interviews with structured questionnaires. Measurements included sociodemographic, medication-related, social support, HIV-stigma, and QoL variables. RESULTS In total, 634 PLHIV agreed to participate in this study. A multivariate linear regression analysis showed that being older, having a job, living in an urban area, having better access to healthcare services, adhering to medication, being in an antiretroviral therapy (ART) program for more than 1 year, experiencing a lower level of stigma, and receiving more social support were associated with a better QoL. The regression model had an adjusted R2 of 0.21. CONCLUSIONS Findings from this research have significant policy implications. Policies focused on reducing social stigma and promoting medication adherence will likely have a positive impact on the QoL of PLHIV. Increasing public awareness and acceptance of PLHIV in Indonesia remains challenging, but would likely have significant impacts. Furthermore, interventions should also focus on reducing disparities in QoL between PLHIV living in rural areas and those in urban areas.
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Affiliation(s)
- Sri Sunaringsih Ika Wardojo
- School of Public Health, Taipei Medical University, Taipei, Taiwan
- Faculty of Health Science, University of Muhammadiyah, Malang, Indonesia
| | - Ya-Li Huang
- School of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical Univeristy, Taipei, Taiwan
| | - Kun-Yang Chuang
- School of Public Health, Taipei Medical University, Taipei, Taiwan
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Mellgren Å, Eriksson LE, Reinius M, Marrone G, Svedhem V. Longitudinal trends and determinants of patient-reported side effects on ART-a Swedish national registry study. PLoS One 2020; 15:e0242710. [PMID: 33362248 PMCID: PMC7757802 DOI: 10.1371/journal.pone.0242710] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/07/2020] [Indexed: 01/19/2023] Open
Abstract
Introduction The use of patient-reported outcomes (PROs) to systematically quantify adverse events (AE) will assist in the improvement of medical care and the QoL of patients living with HIV (PLWH). The aim of this study was to investigate the associations between self-reported side effects and other PROs, demographics and laboratory data, and further evaluate the Health Questionnaire (HQ) as a tool for following trends in patient-reported side effects over time in relation to trends in prescribed third agent in ART. Materials and methods The Swedish National Registry InfCareHiv includes an annual self-reported nine-item HQwhich is used in patient-centered HIV care in all Swedish HIV units. In this study, the experience of side effects was addressed. We analyzed 9,476 HQs completed by 4,186 PLWH together with details about their prescribed ART and relevant biomarkers collected during 2011–2017. Data were analyzed using descriptive statistics, Pearson’s correlation coefficient and mixed logistic regression. Results The cross-sectional analysis of the HQs showed that the frequency of reported side effects decreased from 32% (2011) to 15% (2017). During the same period, there was a shift in ART prescription from efavirenz (EFV) to dolutegravir (DTG) (positive correlation coefficient r = 0.94, p = 0.0016). Further, PLWH who reported being satisfied with their physical health (OR: 0.47, p = <0.001) or psychological health (OR: 0.70, p = 0.001) were less likely to report side effects than those less satisfied. Conclusions Self-reported side effects were found to have a close relationship with the patient’s ratings of their overall health situation and demonstrated a strong correlation with the sharp decline in use of EFV and rise in use of DTG, with reported side effects being halved. This study supports the feasibility of using the HQ as a tool for longitudinal follow up of trends in PROs.
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Affiliation(s)
- Åsa Mellgren
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars E. Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- School of Health Sciences, City, University of London, London, United Kingdom
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Reinius
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Gaetano Marrone
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Veronica Svedhem
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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Mora M, Goodyear T, Marcellin F, Shoveller J, Di Beo V, Calzolaio C, Sogni P, Wittkop L, Zucman D, Poizot-Martin I, Lacombe K, Salmon-Céron D, Knight R, Carrieri P. Life after hepatitis C cure in HIV-infected people who inject drugs and men who have sex with men treated with direct-acting antivirals in France: Health perceptions and experiences from qualitative and quantitative findings (ANRS CO13 HEPAVIH). J Viral Hepat 2020; 27:1462-1472. [PMID: 32810905 PMCID: PMC7935320 DOI: 10.1111/jvh.13378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/17/2022]
Abstract
There remains a substantial gap in our understandings of the life experiences of patients following HCV cure among HIV-HCV-co-infected people who inject drugs (PWID) and men who have sex with men (MSM), two key populations targeted for HCV elimination. We described the experiences and perspectives of HIV-positive PWID and MSM, HCV-cured following treatment with direct-acting antivirals (DAA). We used an exploratory sequential mixed approach using both qualitative data (semi-structured interviews with 27 PWID and 20 MSM) and quantitative data (self-administered questionnaires with 89 PWID) via the prospective ANRS CO13 HEPAVIH cohort. PWID reported improvements in physical health-related quality of life (HRQL) and self-reported symptoms following treatment, but no significant change in mental HRQL. During interviews, several MSM, more recently diagnosed with HCV, expressed less concern regarding HCV than HIV infection and interpreted improvements in their overall well-being after HCV cure to be more related to a closer connection with healthcare providers than with viral elimination. By contrast, PWID, particularly those previously exposed to interferon-based treatments, described major improvements in their physical HRQL. Both MSM and PWID reported improvements in cognitive or psychological wellbeing, and a majority of them reported some degree of concern over potential HCV reinfection. To conclude, though health benefits of HCV cure concern both groups, HIV-infected PWID and MSM may have different representations and experiences following DAA treatment, related to their history with HCV. They are thus likely to benefit from holistic, post-treatment follow-up care that is responsive to their evolving health and social contexts.
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Affiliation(s)
- Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Trevor Goodyear
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Fabienne Marcellin
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Jeannie Shoveller
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Vincent Di Beo
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Chiara Calzolaio
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France,Ecole des Hautes Etudes en Sciences Sociales (EHESS), Institut de Recherche Interdisciplinaire Sur Les Enjeux Sociaux (Iris), Paris, France
| | - Philippe Sogni
- Université Paris Descartes, Paris, France,INSERM U1223, Institut Pasteur, Paris, France,Service d’Hépatologie, AP-HP, Hôpital Cochin, Paris, France
| | - Linda Wittkop
- University of Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France,CHU de Bordeaux, Pole de santé Publique, Bordeaux, France
| | - David Zucman
- Service de Médecine Interne, Hôpital Foch, Suresnes, France
| | - Isabelle Poizot-Martin
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France,Aix Marseille Univ, APHM Sainte- Marguerite, Service d’Immuno-Hématologie Clinique, Marseille, France
| | - Karine Lacombe
- Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Antoine, Service Maladies infectieuses et tropicales, Paris, France,UMPC (Université Pierre et Marie Curie), UMR S1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - Dominique Salmon-Céron
- Université Paris Descartes, Paris, France,Assistance Publique des Hôpitaux de Paris, Hôpital Cochin, Service Maladies infectieuses et tropicales, Paris, France
| | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
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10
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Kall M, Marcellin F, Harding R, Lazarus JV, Carrieri P. Patient-reported outcomes to enhance person-centred HIV care. Lancet HIV 2019; 7:e59-e68. [PMID: 31776101 DOI: 10.1016/s2352-3018(19)30345-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 12/19/2022]
Abstract
Quality of life has been proposed as the fourth 90 to complement the UNAIDS 90-90-90 targets to monitor the global HIV response, highlighting a need to address the holistic needs of people living with HIV beyond viral suppression. This proposal has instigated a wider discussion about the use of patient-reported outcomes (PROs) to improve the treatment and care of an ageing HIV population with increasing comorbidities and a disproportionate burden of social problems. PROs can provide a first-hand assessment of the impact of HIV treatment and care on patients' quality of life, including symptoms. The field of PRO measures is rapidly expanding but still no gold standard exists, raising concerns about tool selection. Challenges also remain in the collection, interpretation, and use of PRO data to improve the performance of the health system. An emerging concern is how to adapt PROs to different sociocultural and geographical settings.
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Affiliation(s)
- Meaghan Kall
- HIV/STI Department, National Infection Service, Public Health England, London, UK.
| | - Fabienne Marcellin
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, Cicely Saunders Institute, Kings College London, London, UK
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Patrizia Carrieri
- Aix Marseille University, Institut National de la Santé et de la Recherche Médicale, Institution Française Publique de Recherche, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France; Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
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11
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Tang Q, Lu H. Challenges to eliminating the AIDS pandemic in China. Glob Health Med 2019; 1:16-19. [PMID: 33330749 DOI: 10.35772/ghm.2019.01013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/30/2019] [Accepted: 10/03/2019] [Indexed: 11/08/2022]
Abstract
Based on data from the Chinese Center for Disease Control and Prevention (CDC), there were a total of 861,042 people with human immunodeficiency virus (HIV)/ immune deficiency syndrome (AIDS) as of December 31, 2018 in China, a total of 148,589 new HIV infections, and 38,134 AIDS-related deaths in the year 2018. As of 2017, only 74% of people living with HIV knew their status, 80% of people living with HIV were receiving treatment, and 91% were virally suppressed in China. Although mankind has made great progress in the fight against AIDS in recent years, the vision of ending the AIDS epidemic still faces many challenges in China. Due to the huge population and the imbalance in the prevalence of HIV/AIDS in China, expanding HIV screening and early detection remains the key to Chinas response to HIV. Limitations of antiviral therapy (ART), rejection or discontinuation of an immediate ART strategy by people infected with HIV, and the difficult search for a cure for AIDS all limit the coverage and quality of treatment. The high price of drugs and lack of vaccines present enormous challenges; social discrimination still exists, and participation by non-governmental organizations in prevention, treatment, and care is limited. As part of the future response to HIV, HIV eradication programs should continue to be explored, and attention should be paid to long-term care for people living with HIV.
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Affiliation(s)
- Qi Tang
- Scientific Research Center, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.,Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hongzhou Lu
- Scientific Research Center, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.,Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.,Department of Infectious Disease, Huashan Hospital Affiliated to Fudan University, Shanghai, China
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12
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Patient Self-Reported Adherence to Ritonavir-Boosted Darunavir Combined With Either Raltegravir or Tenofovir Disoproxil Fumarate/Emtricitabine in the NEAT001/ANRS143 Trial. J Acquir Immune Defic Syndr 2019; 79:481-490. [PMID: 30365452 PMCID: PMC6250251 DOI: 10.1097/qai.0000000000001834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: The NEAT001/ANRS143 trial demonstrated noninferiority of ritonavir-boosted darunavir combined with either raltegravir (RAL + DRV/r) or tenofovir disoproxil fumarate/emtricitabine (TDF/FTC + DRV/r) in HIV-positive, antiretroviral-naive adults. In post hoc analyses, however, RAL + DRV/r showed inferiority in patients with baseline CD4+ <200/mm3 and HIV-1 RNA ≥100,000 copies per milliliter. This preplanned ancillary study was conducted to assess whether differences in adherence might explain efficacy results. Setting: Phase III, open-label, randomized, multicenter study in 15 European countries (ClinicalTrials.gov, NCT01066962). Methods: Seven hundred seventy-four participants self-reported adherence (modified AIDS Clinical Trials Group questionnaire) over 96 weeks [383 RAL + DRV/r (twice daily; 5 pills/day), 391 TDF/FTC + DRV/r (once daily; 4 pills/day)]. Primary endpoint was ≥95% versus <95% adherence to prescribed doses recorded (1) over the last 4 days or (2) on the visual analogue scale over the last 30 days. Results: Characteristics, except age, were similar between arms; 9% had CD4+ <200 cells/mm3 and HIV-1 RNA ≥100,000 copies per milliliter. Adherence ≥95% in the last 4 days (P = 0.029) or at the visual analogue scale (P = 0.0072) was higher with TDF/FTC + DRV/r than with RAL + DRV/r. Adherence ≥95% over the last 4 days was associated with lower probability of virological failure (P = 0.015). Adherence in patients with baseline CD4+ <200 cells/mm3 and HIV-1 RNA ≥100,000 copies per milliliter was similar to the rest of the population, and not significantly associated with efficacy measures, with no significant differences between arms. Conclusion: Adherence was high and slightly better in the TDF/FTC + DRV/r than in the RAL + DRV/r arm. No convincing evidence was found that higher failure rate in the RAL + DRV/r arm in the subgroup with worse baseline viroimmunological status is caused by adherence differences.
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13
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Sofeu CL, Tejiokem MC, Penda CI, Protopopescu C, Ateba Ndongo F, Tetang Ndiang S, Guemkam G, Warszawski J, Faye A, Giorgi R. Early treated HIV-infected children remain at risk of growth retardation during the first five years of life: Results from the ANRS-PEDIACAM cohort in Cameroon. PLoS One 2019; 14:e0219960. [PMID: 31318938 PMCID: PMC6638950 DOI: 10.1371/journal.pone.0219960] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/06/2019] [Indexed: 01/17/2023] Open
Abstract
Background Long-term growth in HIV-infected infants treated early in resource-limited settings is poorly documented. Incidence of growth retardation, instantaneous risk of death related to malnutrition and growth parameters evolution during the first five years of life of uninfected and early treated HIV-infected children were compared and associated factors with growth retardation were identified. Methods Weight-for-age (WAZ), weight-for-length (WLZ), and length-for-age (LAZ) Z-scores were calculated. The ANRS-PEDIACAM cohort includes four groups of infants with three enrolled during the first week of life: HIV-infected (HI, n = 69), HIV-exposed uninfected (HEU, n = 205) and HIV-unexposed uninfected (HUU, n = 196). The last group included HIV-infected infants diagnosed before 7 months of age (HIL, n = 141). The multi-state Markov model was used to describe the incidence of growth retardation and identified associated factors. Results During the first 5 years, 27.5% of children experienced underweight (WAZ<-2), 60.4% stunting (LAZ<-2) and 41.1% wasting (WLZ<-2) at least once. The instantaneous risk of death observed from underweight state (35.3 [14.1–88.2], 84.0 [25.5–276.3], and 6.0 [1.5–24.1] per 1000 person-months for 0–6 months, 6–12 months, and 12–60 months respectively) was higher than from non-underweight state (9.6 [5.7–16.1], 20.1 [10.3–39.4] and 0.3 [0.1–0.9] per 1000 person-months). Compared to HEU, HIL and HI children were most at risk of wasting (adjusted HR (aHR) = 4.3 (95%CI: 1.9–9.8), P<0.001 and aHR = 3.3 (95%CI: 1.4–7.9), P = 0.01 respectively) and stunting for HIL (aHR = 8.4 (95%CI: 2.4–29.7). The risk of underweight was higher in HEU compared to HUU children (aHR = 5.0 (CI: 1.4–10.0), P = 0.001). Others associated factors to growth retardation were chronic pathologies, small size at birth, diarrhea and CD4< 25%. Conclusions HIV-infected children remained at high risk of wasting and stunting within the first 5 years period of follow-up. There is a need of identifying suitable nutritional support and best ways to integrate it with cART in pediatric HIV infection global care.
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Affiliation(s)
- Casimir Ledoux Sofeu
- Centre Pasteur du Cameroun, Service d’épidémiologie et de santé publique, Yaoundé, Cameroun
- Aix-Marseille Univiversité, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, France
- Université de Bordeaux, ISPED, INSERM Bordeaux Population health U1219 (Biostatistic), France
- * E-mail:
| | | | - Calixte Ida Penda
- Université de Douala, Faculté de Médecine et de Sciences Pharmaceutiques, Cameroun
- Hôpital de Jour, Hôpital Laquintinie, Douala, Cameroun
| | - Camelia Protopopescu
- Aix-Marseille Univiversité, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, France
| | | | | | - Georgette Guemkam
- Centre Mère et Enfant de la Fondation Chantal Biya, Yaoundé, Cameroun
| | - Josiane Warszawski
- INSERM U1018 (CESP)—Equipe 4 (VIH et IST), Le Kremlin Bicêtre, France
- Assistance Publique des Hôpitaux de Paris, Service d’Epidémiologie et de Santé Publique, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- Université de Paris Sud 11, Paris, France
| | - Albert Faye
- Assistance Publique des Hôpitaux de Paris, Pédiatrie Générale, Hôpital Robert Debré, Paris, France
- Université Paris 7 Denis Diderot, Paris Sorbonne Cité, Paris, France
- INSERM UMR 1123 (ECEVE), France
| | - Roch Giorgi
- Aix-Marseille Univiversité, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, France
- APHM, Hôpital de la Timone, Service Biostatistique et Technologies de l’Information et de la Communication, Marseille, France
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14
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Chemtob D, Mor Z, Harel N, Averick N. HIV infection among men who have sex with men in Israel: a 35-year epidemiological and clinical overview, 1981-2015. BMC Public Health 2019; 19:747. [PMID: 31196014 PMCID: PMC6567630 DOI: 10.1186/s12889-019-7000-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 05/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study is the first to describe major epidemiological trends and clinical characteristics among Israeli men who have sex with men (MSM), who are at a higher risk for HIV infection. METHODS This retrospective study includes all individuals reported to the Israeli Ministry of Health with HIV and self-identified as MSM between 1981 and 2015. The incidence rates of HIV infection and AIDS-defining diseases were analyzed and Kaplan-Meier survival estimates were calculated from time of HIV infection notification to AIDS diagnosis and death across three consecutive periods representing antiretroviral treatment availability. RESULTS The trend of increase in HIV incidence is similar to Western Europe, although Israeli rates are lower. Of 2052 HIV/AIDS Israeli MSM diagnosed during the follow-up, 296 (14.6%) developed AIDS. MSM constitute 28.4% of all HIV/AIDS cases and 41.5% of cases among men. Average times from HIV-notification until AIDS diagnosis were 15.5 [14.0-16.9], 16.0 [15.5-16.4], and 6.7 [6.7-6.8] years, within 1981-1996, 1997-2007, and 2008-2015, respectively. The HIV-incidence rate among Israeli MSM slightly declined from 2012, after peaking in 2011 at 6.2 per 100,000. CONCLUSIONS The recent reduction in HIV-incidence and in AIDS diagnoses among Israeli MSM is encouraging. Nevertheless, the disproportionate incidence of HIV among MSM requires sustained efforts to abate further infections.
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Affiliation(s)
- D Chemtob
- Department of Tuberculosis & AIDS, Ministry of Health, Jerusalem, Israel. .,Faculty of Medicine, Braun School of Public Health & Community Medicine, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
| | - Z Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel.,School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
| | - N Harel
- Department of Tuberculosis & AIDS, Ministry of Health, Jerusalem, Israel
| | - N Averick
- Department of Tuberculosis & AIDS, Ministry of Health, Jerusalem, Israel
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15
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CEYLAN E, KOÇ A, İNKAYA AÇ, ÜNAL S. Determination of medication adherence and related factors among people living with HIV/AIDS in a Turkish university hospital. Turk J Med Sci 2019; 49:198-205. [PMID: 30764598 PMCID: PMC7350793 DOI: 10.3906/sag-1802-137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background/aim Widespread use of antiretroviral treatment (ART) has led to decrease in the incidence of HIV/AIDS-related mortality. Besides the availability of ART, medication adherence is essential for treatment success. There is a scarcity of data reported from Turkey regarding ART adherence among people living with HIV/AIDS (PLWHA). Therefore, this study was undertaken to determine medication adherence and related factors among PLWHA in Turkey. Materials and methods The sample consisted of 158 PLWHA, who were being followed up at Infectious Diseases Outpatient Clinic of Hacettepe University Hospital. Data were collected using an individual questionnaire and the Turkish version of the Morisky Medication Adherence Scale. Results The median patient age was 38 years, 80.4% were male, and 51.3% were married. The median duration of both HIV infection and ART was 3 years. Sixty-one percent used two drug regimens. Sixty-one percent were highly adherent to ART while 37.9% were moderately adherent. The absence/presence of social support resources, disease duration, ART duration, and being informed about the ART regimen were statistically associated with medication adherence. Conclusion Our results suggest that medication adherence is excellent among Turkish PLWHA. Interventions, including effective social support, and continuous counseling about ART, might further boost the adherence of PLWHA.
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Affiliation(s)
- Erdal CEYLAN
- Department of Nursing, Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, AnkaraTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Ayşegül KOÇ
- Department of Nursing, Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, AnkaraTurkey
| | - Ahmet Çağkan İNKAYA
- Department of Infectious Diseases, Faculty of Medicine, Hacettepe University, AnkaraTurkey
| | - Serhat ÜNAL
- Department of Infectious Diseases, Faculty of Medicine, Hacettepe University, AnkaraTurkey
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16
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Tie Y, Skarbinski J, Qin G, Frazier EL. Prevalence and Patterns of Antiretroviral Therapy Prescription in the United States. Open AIDS J 2018. [DOI: 10.2174/1874613601812010181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background:
The use of Antiretroviral Therapy (ART) in HIV-infected persons has proven to be effective in the reduction of risk of disease progression and prevention of HIV transmission.
Objective:
U.S. Antiretroviral Therapy (ART) guidelines specify recommended initial, alternative initial, and not-recommended regimens, but data on ART prescribing practices and real-world effectiveness are sparse.
Methods:
Nationally representative annual cross sectional survey of HIV-infected adults receiving medical care in the United States, 2009-2012 data cycles. Using data from 18,095 participants, we assessed percentages prescribed ART regimens based on medical record documentation and the associations between ART regimens and viral suppression (most recent viral load test <200 copies/ml in past year) and ART-related side effects.
Results:
Among HIV-infected adults receiving medical care in the United States, 91.8% were prescribed ART; median time since ART initiation to interview date was 9.8 years. The percentage prescribed ART was significantly higher in 2012 compared to 2009 (92.7% vs 88.7%; p < 0.001). Of those prescribed ART, 51.6% were prescribed recommended initial regimens, 6.1% alternative initial regimens, 29.0% not-recommended as initial regimens, and 13.4% other regimens. Overall, 79.5% achieved viral suppression and 15.7% reported side effects. Of those prescribed ART and initiated ART in the past year, 80.5% were prescribed recommended initial regimens.
Conclusion:
Among persons prescribed ART, the majority were prescribed recommended initial regimens. Monitoring of ART use should be continued to provide ongoing assessments of ART effectiveness and tolerability in the United States.
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17
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Is on-Demand HIV Pre-exposure Prophylaxis a Suitable Tool for Men Who Have Sex With Men Who Practice Chemsex? Results From a Substudy of the ANRS-IPERGAY Trial. J Acquir Immune Defic Syndr 2018; 79:e69-e75. [DOI: 10.1097/qai.0000000000001781] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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18
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Costa M, Marcellin F, Coste M, Barré T, Nordmann S, Mora M, Maradan G, Tanti M, Cutarella C, Casanova D, Levy-Bellaiche S, Polomeni P, Simon N, Roux P, Carrieri MP. Access to care for people with alcohol use disorder in France: a mixed-method cross-sectional study protocol (ASIA). BMJ Open 2018; 8:e024669. [PMID: 30269077 PMCID: PMC6169764 DOI: 10.1136/bmjopen-2018-024669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Alcohol use disorder (AUD) is a major public health concern worldwide. In France, only 10% of people with AUD (PWAUD) receive medical care. General practitioners (GP) are one of the main entry points for AUD care. The present ongoing study, entitled ASIA (Access to Care and Indifference toward Alcohol, Accès aux Soins et Indifference à l'Alcool in French), aims to improve knowledge about factors associated with access to care for AUD by exploring related GP and PWAUD practices, experiences and perceptions. METHODS AND ANALYSIS The ASIA project is an ongoing cross-sectional multisite study based on a complementary mixed-method approach (quantitative and qualitative) using a convergent parallel design. The double-perspective design of the study will enable us to collect and compare data regarding both PWAUD and GP points of view. For the PWAUD quantitative study, 260 PWAUD will be interviewed using a telephone-based questionnaire. For the qualitative study, 36 PWAUD have already been interviewed. The GP quantitative study will include 100 GP in a 15 min survey. Fifteen GP have already participated in semistructured interviews for the qualitative study. Logistic regression will be used to identify predictors for access to care. With respect to data analyses, qualitative interviews will be analysed using semantic analysis while quantitative logistic regression will be used for quantitative interviews. ETHICS AND DISSEMINATION This study was approved by the CNIL (French National Commission on Informatics and Liberties) (approval reference number: C16-10, date of approval: 17 July 2017), the CCTIRS (Advisory Committee on Information Processing in Material Research in the Field of Health) and the CEEI (Evaluation and Ethics Committee) (approval reference number: 16-312, date of approval: 8 July 2016) of INSERM (French National Institute of Health and Medical Research). Results from ASIA will be disseminated in peer-reviewed publications, conference presentations, reports and in a PhD thesis.
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Affiliation(s)
- Marie Costa
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Fabienne Marcellin
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marion Coste
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Tangui Barré
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Sandra Nordmann
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marion Mora
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Gwenaëlle Maradan
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marc Tanti
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
- CESPA, Centre d’Epidémiologie et de Santé Publique des Armées, Marseille, France
| | | | - Danielle Casanova
- CSAPA, Centre de soins, d’accompagnement et de prévention en addictologie, Arles, France
| | | | | | - Nicolas Simon
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Perrine Roux
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Maria-Patrizia Carrieri
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
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Zhou G, Li X, Qiao S, Shen Z, Zhou Y. Influence of Side Effects on ART Adherence Among PLWH in China: The Moderator Role of ART-Related Knowledge. AIDS Behav 2018; 22:961-970. [PMID: 28509998 DOI: 10.1007/s10461-017-1791-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Despite the medical advancements in HIV treatment, realities of side effects are faced by people living with HIV (PLWH) who receive antiretroviral therapy (ART). Mixed findings have been reported on the association between side effects and ART adherence. However, few studies have explored the combined side effects and behavior-related information on medication adherence. The aim of the current study is to examine moderator role of ART-related knowledge between side effects and ART adherence. A cross-sectional survey was conducted among 2987 PLWH from October 2012 to August 2013 in China. Of the total sample, 2095 patients had received ART and provided ART adherence. Side effects, ART-related knowledge, and ART adherence, as well as potential covariates were assessed. The results revealed that there was a negative relationship of side effects and ART adherence existed among low and medium levels of ART-related knowledge, but not among high level of knowledge. Future interventions to promote HIV medication adherence should focus on providing behavior-related information education among PLWH.
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Affiliation(s)
- Guangyu Zhou
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA.
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, People's Republic of China.
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning, People's Republic of China
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, People's Republic of China
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VanderDrift LE, Ioerger M, Mitzel LD, Vanable PA. Partner Support, Willingness to Sacrifice, and HIV Medication Self-Efficacy. AIDS Behav 2017; 21:2519-2525. [PMID: 28155037 DOI: 10.1007/s10461-017-1698-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
When taken as prescribed, highly active anti-retroviral medications allow individuals with HIV to live long, healthy lives. Nevertheless, poor adherence is common. In the current study, we examined why some people fail to feel efficacious to adhere, focusing on their interpersonal relationships. Given past findings that some individuals with primary partners adhere better than those without, whereas others adhere worse, we examined whether relationship dynamics influence the association between support from a primary partner and adherence self-efficacy. Specifically, we hypothesized and found that relationship partners' support regarding medication adherence undermines self-efficacy when the partner is perceived as unwilling to sacrifice for the relationship. We discuss the implications of these results for intervention construction and for understanding the power of the relationship context on HIV medication adherence.
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21
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Flicoteaux R, Protopopescu C, Tibi A, Blanchon T, Werf SVD, Duval X, Mosnier A, Charlois-Ou C, Lina B, Leport C, Chevret S. Factors associated with non-persistence to oral and inhaled antiviral therapies for seasonal influenza: a secondary analysis of a double-blind, multicentre, randomised clinical trial. BMJ Open 2017; 7:e014546. [PMID: 28698321 PMCID: PMC5734282 DOI: 10.1136/bmjopen-2016-014546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 05/10/2017] [Accepted: 06/01/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We aimed to evaluate and compare non-adherence to oral and inhaled antiviral therapies prescribed of a randomised clinical trial in outpatients with influenza A infection. DESIGN A parallel, three-arm, double-blinded trial randomly allocated antiviral therapies twice daily for 5 days: (1) oral oseltamivir plus inhaled zanamivir (arm OZ); (2) oseltamivir plus inhaled placebo (arm Opz); or (3) oral placebo plus inhaled zanamivir (arm poZ). Analysis of non-adherence was a secondary objective of the trial. SETTINGS Outpatients were enrolled by 145 general practitioners throughout France during the 2008-2009 seasonal influenza epidemics. PARTICIPANTS A total of 541 adults presenting with influenza-like illness for less than 36 hours. PRIMARY OUTCOMES Non-persistence, the time between inclusion and the last dose treated as a failure time, was used as the primary endpoint. RESULTS The proportions of patients who persisted on treatment until the end of prescription were estimated at 85.73% (±3.28%) for the oral route and 82.73% (±3.44%) for the inhaled route. Based on multivariable models, non-persistence was associated with a PCR confirmation of influenza for both the oral (HR=0.54, p=0.010) and inhaled (HR=0.59, p=0.018) drugs and antibiotic coprescriptions (HR=2.07, p=0.007; and HR=1.88, p=0.017, respectively) and active combination treatment (HR=1.71, p=0.035; and HR=1.58, p=0.035, respectively). The hazard of non-persistence of the inhaled therapy was increased compared with that of the oral therapy (HR=1.23, p=0.043). CONCLUSION In addition to the clinical and virological profiles of influenza infection, non-persistence may have been influenced by an active combination and the route of administration. RCT REGISTRATION NUMBER NCT00799760. This is a post-result analysis.
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Affiliation(s)
- Remi Flicoteaux
- IAME (Infection, Antimicrobien, Modélisation, Evolution), UMR-1137, Inserm, Université Paris Diderot, Sorbonne Paris Cite, Paris, France
- Service de Biostatistique et Information Médicale, ECSTRA Team, UMR-1153, Inserm, Université Paris Diderot, Sorbonne Paris Cité, Hôpital Saint Louis, Paris, France
| | - Camelia Protopopescu
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France., Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France., Marseille, France
| | - Annick Tibi
- Faculte de Pharmacie, Université Paris Descartes, Paris, France
| | - Thierry Blanchon
- Faculté de Médecine, Inserm Université Pierre et Marie Curie, U1136 - Institut Pierre Louis d’épidémiologie et de santé publique (IPLESP), Paris, France
| | - Sylvie Van Der Werf
- Institut Pasteur, Centre National de Référence des virus influenzae (Région-Nord), Unité de Génétique Moléculaire des Virus à ARN, Paris, France
| | - Xavier Duval
- IAME (Infection, Antimicrobien, Modélisation, Evolution), UMR-1137, Inserm, Université Paris Diderot, Sorbonne Paris Cite, Paris, France
| | - Anne Mosnier
- Réseau des Groupes Régionaux d’Observation de la Grippe (GROG), Coordination Nationale, Paris, France
| | - Cécile Charlois-Ou
- IAME (Infection, Antimicrobien, Modélisation, Evolution), UMR-1137, Inserm, Université Paris Diderot, Sorbonne Paris Cite, Paris, France
| | - Bruno Lina
- Faculté de Médecine Lyon Est, VirPatH, EA 4610, Université Claude Bernard Lyon 1, Lyon, France
- Laboratoire de Virologie & CNR des virus influenzae (site Lyon), Hospices Civils de Lyon, Lyon, France
| | - Catherine Leport
- IAME (Infection, Antimicrobien, Modélisation, Evolution), UMR-1137, Inserm, Université Paris Diderot, Sorbonne Paris Cite, Paris, France
| | - Sylvie Chevret
- Service de Biostatistique et Information Médicale, ECSTRA Team, UMR-1153, Inserm, Université Paris Diderot, Sorbonne Paris Cité, Hôpital Saint Louis, Paris, France
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22
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Madeddu G, Rusconi S, Cozzi-Lepri A, Di Giambenedetto S, Bonora S, Carbone A, De Luca A, Gianotti N, Di Biagio A, Antinori A. Efficacy and tolerability of switching to a dual therapy with darunavir/ritonavir plus raltegravir in HIV-infected patients with HIV-1 RNA ≤50 cp/mL. Infection 2017; 45:521-528. [PMID: 28477212 DOI: 10.1007/s15010-017-1018-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/13/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Nucleos(t)ide reverse transcriptase inhibitors (NRTI) toxicity may represent a threat for long-term success of combined antiretroviral therapy. Some studies have suggested a possible improvement of NRTI-related toxicity after switching to NRTI-sparing regimens. OBJECTIVES We aimed to explore the efficacy and tolerability of switching to darunavir/ritonavir (DRV/r) plus raltegravir (RAL) while having a viral load (VL) ≤50 copies/mL in the clinical setting. STUDY DESIGN Treatment-experienced HIV 1-infected patients enrolled in the ICONA Foundation Study cohort were included if they switched their current regimen to DRV/r + RAL with a HIV-RNA ≤50 copies/mL. Different definitions of virological failure (VF) and treatment failure (TF) were employed. Kaplan-Meier curves and Cox regression models were performed to estimate time to event probability. RESULTS We included 72 HIV-infected patients, 22 (31%) of these were female, 31 (43%) men who have sex with men (MSM) amd 15 (21%) had hepatitis co-infections. Median age was 44 (IQR: 35-50) years amd CD4 count was 389 (IQR 283-606) cells/mmc. Median follow-up time for TF was 24 (IQR 9-31) months. Twenty-five discontinuations occurred (60% simplifications); only 2 (8%) were toxicity-driven (lipid elevations). The probability of VF (confirmed VL >50 copies/mL) was estimated at 7% [95% confidence interval (CI) 1-13%] by 12 and 9% (95% CI 2-16%) by 24 months. When considering TF, we found a probability of stop/intensification/single VL > 200 copies/mL of 13% (95% CI 1-17%) and 22% (95% CI 11-33%) by 12 and 24 months. Female gender (adjusted relative hazard, ARH = 0.10; 95% CI 0.01-0.74; p = 0.024) and older age (AHR = 0.50 per 10 years older; 95% CI 0.25-0.99; p = 0.045) were associated with a lower risk of TF. A previous PI failure was strongly associated with TF (AHR = 52.6, 95% CI 3.6-779; p = 0.004). CONCLUSIONS DRV/r + RAL is a valuable NRTI-sparing option, especially in female and older patients, with a relatively low risk of VF and good tolerability after 2 years since start in an ART-experienced population. However, previous PI-failure should be a limiting factor for this strategy.
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Affiliation(s)
- Giordano Madeddu
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy.
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Alessandro Cozzi-Lepri
- Department of Infection and Population Health, Division of Population Health, Hampstead Campus, University College London, London, UK
| | - Simona Di Giambenedetto
- Catholic University of the Sacred Heart, Milan, Unit of Infectious Diseases, Agostino Gemelli Polyclinic Foundation, Rome, Italy
| | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Alessia Carbone
- Infectious Diseases Department, San Raffaele Scientific Institute, Università vita e salute, Milan, Italy
| | - Andrea De Luca
- Division of Infectious Diseases, Department of Medical Biotechnologies, University of Siena and Siena University Hospital, Siena, Italy
| | - Nicola Gianotti
- Infectious Diseases Department, San Raffaele Scientific Institute, Università vita e salute, Milan, Italy
| | - Antonio Di Biagio
- Unit of Infectious Diseases, IRCCS San Martino Hospital-IST, Genoa, Italy
| | - Andrea Antinori
- Clinical Department, National Institute of Infectious Diseases 'Lazzaro Spallanzani', Rome, Italy
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23
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Kimulwo MJ, Okendo J, Aman RA, Ogutu BR, Kokwaro GO, Ochieng DJ, Muigai AWT, Oloo FA, Ochieng W. Plasma nevirapine concentrations predict virological and adherence failure in Kenyan HIV-1 infected patients with extensive antiretroviral treatment exposure. PLoS One 2017; 12:e0172960. [PMID: 28235021 PMCID: PMC5325546 DOI: 10.1371/journal.pone.0172960] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 02/13/2017] [Indexed: 11/19/2022] Open
Abstract
Treatment failure is a key challenge in the management of HIV-1 infection. We conducted a mixed-model survey of plasma nevirapine (NVP) concentrations (cNVP) and viral load in order to examine associations with treatment and adherence outcomes among Kenyan patients on prolonged antiretroviral therapy (ART). Blood plasma was collected at 1, 4 and 24 hours post-ART dosing from 58 subjects receiving NVP-containing ART and used to determine cNVP and viral load (VL). Median duration of treatment was 42 (range, 12–156) months, and 25 (43.1%) of the patients had virologic failure (VF). cNVP was significantly lower for VF than non- VF at 1hr (mean, 2,111ng/ml vs. 3,432ng/ml, p = 0.003) and at 4hr (mean 1,625ng/ml vs. 3,999ng/ml, p = 0.001) but not at 24hr post-ART dosing. Up to 53.4%, 24.1% and 22.4% of the subjects had good, fair and poor adherence respectively. cNVP levels peaked and were > = 3μg.ml at 4 hours in a majority of patients with good adherence and those without VF. Using a threshold of 3μg/ml for optimal therapeutic nevirapine level, 74% (43/58), 65.5% (38/58) and 86% (50/58) of all patients had sub-therapeutic cNVP at 1, 4 and 24 hours respectively. cNVP at 4 hours was associated with adherence (p = 0.05) and virologic VF (p = 0.002) in a chi-square test. These mean cNVP levels differed significantly in non-parametric tests between adherence categories at 1hr (p = 0.005) and 4hrs (p = 0.01) and between ART regimen categories at 1hr (p = 0.004) and 4hrs (p<0.0001). Moreover, cNVP levels correlated inversely with VL (p< = 0.006) and positively with adherence behavior. In multivariate tests, increased early peak NVP (cNVP4) was independently predictive of lower VL (p = 0.002), while delayed high NVP peak (cNVP24) was consistent with increased VL (p = 0.033). These data strongly assert the need to integrate plasma concentrations of NVP and that of other ART drugs into routine ART management of HIV-1 patients.
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Affiliation(s)
- Maureen J. Kimulwo
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- ITROMID, Jomo Kenyatta University of Science and Technology, Nairobi, Kenya
| | - Javan Okendo
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
| | - Rashid A. Aman
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
- African Centre for Clinical Trials, Nairobi, Kenya
| | - Bernhards R. Ogutu
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Gilbert O. Kokwaro
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
| | - Dorothy J. Ochieng
- School of Pharmacy, MCPHS University, Worcester, Massachusetts, United States of America
| | - Anne W. T. Muigai
- ITROMID, Jomo Kenyatta University of Science and Technology, Nairobi, Kenya
| | - Florence A. Oloo
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- Department of Chemical Science and Technology, Technical University of Kenya, Nairobi, Kenya
| | - Washingtone Ochieng
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
- Kenya Medical Research Institute, Nairobi, Kenya
- Immunology and Infectious Diseases Department, Harvard School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
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24
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Fonsah JY, Njamnshi AK, Kouanfack C, Qiu F, Njamnshi DM, Tagny CT, Nchindap E, Kenmogne L, Mbanya D, Heaton R, Kanmogne GD. Adherence to Antiretroviral Therapy (ART) in Yaoundé-Cameroon: Association with Opportunistic Infections, Depression, ART Regimen and Side Effects. PLoS One 2017; 12:e0170893. [PMID: 28141867 PMCID: PMC5283684 DOI: 10.1371/journal.pone.0170893] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 01/12/2017] [Indexed: 12/30/2022] Open
Abstract
Following global efforts to increase antiretroviral therapy (ART) access in Sub-Saharan Africa, ART coverage among HIV-infected Cameroonians increased from 0% in 2003 to 22% in 2014. However, the success of current HIV treatment programs depends not only on access to ART, but also on retention in care and good treatment adherence. This is necessary to achieve viral suppression, prevent virologic failure, and reduce viral transmission and HIV/AIDS-related deaths. Previous studies in Cameroon showed poor adherence, treatment interruption, and loss to follow-up among HIV+ subjects on ART, but the factors that influence ART adherence are not well known. In the current cross-sectional study, patient/self-reported questionnaires and pharmacy medication refill data were used to quantify ART adherence and determine the factors associated with increased risk of non-adherence among HIV-infected Cameroonians. We demonstrated that drug side-effects, low CD4 cell counts and higher viral loads are associated with increased risk of non-adherence, and compared to females, males were more likely to forego ART because of side effects (p<0.05). Univariate logistic regression analysis demonstrated that subjects with opportunistic infections (on antibiotics) had 2.42-times higher odds of having been non-adherent (p<0.001). Multivariable analysis controlling for ART regimen, age, gender, and education showed that subjects with opportunistic infections had 3.1-times higher odds of having been non-adherent (p<0.0003), with significantly longer periods of non-adherence, compared to subjects without opportunistic infections (p = 0.02). We further showed that compared to younger subjects (≤40 years), older subjects (>40 years) were less likely to be non-adherent (p<0.01) and had shorter non-adherent periods (p<0.0001). The presence of depression symptoms correlated with non-adherence to ART during antibiotic treatment (r = 0.53, p = 0.04), and was associated with lower CD4 cell counts (p = 0.04) and longer non-adherent periods (p = 0.04). Change in ART regimen was significantly associated with increased likelihood of non-adherence and increased duration of the non-adherence period. Addressing these underlying risk factors could improve ART adherence, retention in care and treatment outcomes for HIV/AIDS patients in Cameroon.
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Affiliation(s)
- Julius Y. Fonsah
- Department of Neurology, Yaoundé Central Hospital, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Alfred K. Njamnshi
- Department of Neurology, Yaoundé Central Hospital, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Charles Kouanfack
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- HIV-Day Care Service, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Fang Qiu
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Dora M. Njamnshi
- HIV-Day Care Service, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Claude T. Tagny
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | | | | | - Dora Mbanya
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | - Robert Heaton
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, United States of America
| | - Georgette D. Kanmogne
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
- * E-mail:
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25
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Marrone G, Mellgren Å, Eriksson LE, Svedhem V. High Concordance between Self-Reported Adherence, Treatment Outcome and Satisfaction with Care Using a Nine-Item Health Questionnaire in InfCareHIV. PLoS One 2016; 11:e0156916. [PMID: 27310201 PMCID: PMC4911158 DOI: 10.1371/journal.pone.0156916] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/20/2016] [Indexed: 12/29/2022] Open
Abstract
Background In this cross-sectional study we present an integrated analysis of a self-reported Health Questionnaire and socio-demographic and treatment outcome data from the national Swedish HIV cohort, InfCareHIV. Objectives To evaluate the Health Questionnaire and identify the main determinants of adherence. Methods A total of 2,846 patients answered a nine-item disease-specific Health Questionnaire between 2012 and 2014, corresponding to 44% of all active patients in the national InfCareHIV cohort. The questionnaire assessed patient related outcome measures (PROMs) regarding health and antiretroviral treatment (ART) and patient related experience measures (PREMs) regarding involvement in care and satisfaction with the care provider. Result We found the Health Questionnaire to be valid and reliable when used in ordinary clinical practice. There was a high concordance between self-reported adherence to ART in the past seven days and treatment outcome, with 94% of patients who reported optimal adherence having a viral load <50 copies/ml. The main determinants of optimal adherence were heterosexual transmission path, being born in Sweden, being male, not reporting experience of ART side effects and being fully satisfied with care. Conclusion The nine-item Health Questionnaire can identify patients at risk of treatment failure, those in need of clinical assessment of adverse events and those with impaired physical health.
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Affiliation(s)
- Gaetano Marrone
- Department of Infectious Diseases and Clinical Virology, Karolinska University Hospital, Stockholm, Sweden
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
| | - Åsa Mellgren
- Clinic of Infectious Diseases, South Älvsborg Hospital, Borås, Sweden
| | - Lars E. Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- School of Health Sciences, City University London, London, United Kingdom
| | - Veronica Svedhem
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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26
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Stuardo Ávila V, Manriquez Urbina JM, Fajreldin Chuaqui V, Belmar Prieto J, Valenzuela Santibáñez V. Model of socio-cultural dimensions involved in adherence to antiretroviral therapy for HIV/AIDS in public health care centers in Chile. AIDS Care 2016; 28:1441-7. [PMID: 27144342 DOI: 10.1080/09540121.2016.1179252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In Chile, over 14,000 adults are living with HIV receive antiretroviral therapy (HAART). Adequate adherence to HAART has a major impact on survival. There is little consensus on the causes of poor adherence, due to the unique and diverse sociocultural parameters involved in the issue. The objective of this study was to identify sociocultural dimensions that serve as barriers or facilitators to HAART adherence among persons living with HIV/AIDS (PLHIV) in Chile. A qualitative study design, with an exploratory followed by a descriptive phase was conducted. The study population consisted of adults living with HIV/AIDS, with and without HAART. A theoretical sample was designed and three gender profiles defined: women, men, and transwomen. Data collection methods included in-depth interviews by anthropologists in seven public health care centers for PLHIV. The model of sociocultural dimensions indicated that factors associated with family, expectations, gender/sexuality, affect, relationship with HIV, HAART, work, social support and networks, and stigma and discrimination influenced adherence, with different patterns among profiles. This study found that adherence is a dynamic category. It is crucial to consider sociocultural factors in developing strategies to improve HAART adherence.
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Affiliation(s)
- Valeria Stuardo Ávila
- a Programa de Epidemiología, Escuela de Salud Pública , Universidad de Chile , Santiago , Chile
| | | | | | - Julieta Belmar Prieto
- a Programa de Epidemiología, Escuela de Salud Pública , Universidad de Chile , Santiago , Chile
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27
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Galimard JE, Chevret S, Protopopescu C, Resche-Rigon M. A multiple imputation approach for MNAR mechanisms compatible with Heckman's model. Stat Med 2016; 35:2907-20. [PMID: 26893215 DOI: 10.1002/sim.6902] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/11/2016] [Accepted: 01/20/2016] [Indexed: 11/07/2022]
Abstract
Standard implementations of multiple imputation (MI) approaches provide unbiased inferences based on an assumption of underlying missing at random (MAR) mechanisms. However, in the presence of missing data generated by missing not at random (MNAR) mechanisms, MI is not satisfactory. Originating in an econometric statistical context, Heckman's model, also called the sample selection method, deals with selected samples using two joined linear equations, termed the selection equation and the outcome equation. It has been successfully applied to MNAR outcomes. Nevertheless, such a method only addresses missing outcomes, and this is a strong limitation in clinical epidemiology settings, where covariates are also often missing. We propose to extend the validity of MI to some MNAR mechanisms through the use of the Heckman's model as imputation model and a two-step estimation process. This approach will provide a solution that can be used in an MI by chained equation framework to impute missing (either outcomes or covariates) data resulting either from a MAR or an MNAR mechanism when the MNAR mechanism is compatible with a Heckman's model. The approach is illustrated on a real dataset from a randomised trial in patients with seasonal influenza. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jacques-Emmanuel Galimard
- INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), ECSTRA Team, Saint-Louis Hospital, Paris, 75010, France.,Paris Diderot University, Paris 7, SPC, Paris, France
| | - Sylvie Chevret
- INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), ECSTRA Team, Saint-Louis Hospital, Paris, 75010, France.,Paris Diderot University, Paris 7, SPC, Paris, France.,SBIM, Saint-Louis Hospital, APHP, Paris, France
| | | | - Matthieu Resche-Rigon
- INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), ECSTRA Team, Saint-Louis Hospital, Paris, 75010, France.,Paris Diderot University, Paris 7, SPC, Paris, France.,SBIM, Saint-Louis Hospital, APHP, Paris, France
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28
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Hernández Arroyo MJ, Cabrera Figueroa SE, Sepúlveda Correa R, Valverde Merino MP, Luna Rodrigo G, Domínguez-Gil Hurlé A. Influence of the number of daily pills and doses on adherence to antiretroviral treatment: a 7-year study. J Clin Pharm Ther 2015; 41:34-9. [PMID: 26714444 DOI: 10.1111/jcpt.12343] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 11/18/2015] [Indexed: 12/17/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Antiretroviral treatment (ART) is hampered by complicated regimens, high pill burden, drug-drug interactions, and frequent short- and long-term adverse effects, leading to decreased adherence. Over recent years, considerable effort has been directed at developing regimens that are less burdening. We undertook a 7-year retrospective study of the records of 264 HIV-infected subjects enrolled in a pharmaceutical care programme to document the progress made and to study the influence of the number of ART pills and doses on the level of treatment adherence. METHODS Antiretroviral dispensing records were analysed for the number of pills and doses administered and the ART adherence rate estimated. RESULTS AND DISCUSSION In 2005, the patients took a mean of 6·2 pills daily (CI 95%: 5·9-6·6), and 92·9% of them were on a twice-a-day (BID) dosage regimen. By 2012, the mean number of pills was reduced to 4·1 (CI 95%: 3·8-4·4), and only 50·9% were on a BID regimen. No statistically significant relation was observed between number of daily pills and doses and ART adherence reached by the patients in any of the analyses performed. WHAT IS NEW AND CONCLUSIONS There has been a continuous reduction in the number of pills and doses of antiretrovirals taken by individual patients over the last 7 years due largely to the introduction of improved treatments and regimens. More daily pills or doses was not associated with worse ART adherence in our pharmaceutical care programme.
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Affiliation(s)
| | | | | | | | - G Luna Rodrigo
- Infectious Disease Service, University Hospital of Salamanca, Salamanca, Spain
| | - A Domínguez-Gil Hurlé
- Department of Pharmacy and Pharmaceutical Technology, University of Salamanca, Salamanca, Spain
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Predictors of Treatment Response to Tesamorelin, a Growth Hormone-Releasing Factor Analog, in HIV-Infected Patients with Excess Abdominal Fat. PLoS One 2015; 10:e0140358. [PMID: 26457580 PMCID: PMC4601733 DOI: 10.1371/journal.pone.0140358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 09/24/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tesamorelin, a synthetic analog of human growth hormone-releasing factor, decreases visceral adipose tissue (VAT) in human immunodeficiency virus (HIV)-infected patients with lipodystrophy. OBJECTIVES 1) To evaluate the utility of patient characteristics and validated disease-risk scores, namely indicator variables for the metabolic syndrome defined by the International Diabetes Federation (MetS-IDF) or the National Cholesterol Education Program (MetS-NCEP) and the Framingham Risk Score (FRS), as predictors of VAT reduction during tesamorelin therapy at 3 and 6 months, and 2) To explore the characteristics of patients who reached a threshold of VAT <140 cm2, a level associated with lower risk of adverse health outcomes, after 6 months of treatment with tesamorelin. METHODS Data were analyzed from two Phase 3 studies in which HIV-infected patients with excess abdominal fat were randomized in a 2:1 ratio to receive tesamorelin 2 mg (n = 543) or placebo (n = 263) subcutaneously daily for 6 months, using ANOVA and ANCOVA models. RESULTS Metabolic syndrome (MetS-IDF or MetS-NCEP) and FRS were significantly associated with VAT at baseline. Presence of metabolic syndrome ([MetS-NCEP), triglyceride levels >1.7 mmol/L, and white race had a significant impact on likelihood of response to tesamorelin after 6 months of therapy (interaction p-values 0.054, 0.063, and 0.025, respectively). No predictive factors were identified at 3 months. The odds of a VAT reduction to <140 cm2 for subjects treated with tesamorelin was 3.9 times greater than that of subjects randomized to placebo after controlling for study, gender, baseline body mass index (BMI) and baseline VAT (95% confidence interval [CI] 2.03; 7.44). CONCLUSIONS Individuals with baseline MetS-NCEP, elevated triglyceride levels, or white race were most likely to experience reductions in VAT after 6 months of tesamorelin treatment. The odds of response of VAT <140 cm2 was 3.9 times greater for tesamorelin-treated patients than that of patients receiving placebo.
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Mahlich J, Bogner JR, Tomeczkowski J, Stoll M. Treatment strategies for treatment naïve HIV patients in Germany: evidence from claims data. SPRINGERPLUS 2015; 4:306. [PMID: 26155445 PMCID: PMC4486650 DOI: 10.1186/s40064-015-1099-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/15/2015] [Indexed: 11/10/2022]
Abstract
A recent observational study of HIV patients in Germany suggests that treatment naïve patients that are in a more advanced stage of their disease are more likely to receive a treatment regimen based on a boosted protease inhibitor (PI/r) compared with a non-nucleoside reverse-transcriptase-inhibitor (NNRTI) base regimen. To validate those results we analysed claims data of seven German sickness funds from 2009 to 2012 with approximately 4 million beneficiaries. Patients in a more advanced disease state (CDC class C) had a higher likelihood to receive a PI/r based regime rather than a NNRTI based regimen as their initial treatment. There was also a significant correlation between PI/r based regimen and number of comorbidities but not with age. Our results confirm a highly significant relationship between being in a more severe stage of HIV disease and a PI/r based treatment regimen.
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Affiliation(s)
- Jörg Mahlich
- />Janssen K.K., Tokyo, Japan
- />Düsseldorf Institute for Competition Economics (DICE), Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Johannes R Bogner
- />Med. Klinik und Poliklinik IV, Sektion Klinische Infektiologie, University Hospital of Munich, Munich, Germany
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Protopopescu C, Raffi F, Spire B, Hardel L, Michelet C, Cheneau C, Le Moing V, Leport C, Carrieri MP. Twelve-year mortality in HIV-infected patients receiving antiretroviral therapy: the role of social vulnerability. The ANRS CO8 APROCO-COPILOTE cohort. Antivir Ther 2015; 20:763-72. [PMID: 25859625 DOI: 10.3851/imp2960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although the role of clinical/biological factors associated with mortality has already been explored in HIV-infected patients on antiretroviral therapy (ART), to date little attention has been given to the potential role of social vulnerability. This study aimed to construct an appropriate measure of social vulnerability and to evaluate whether this measure is predictive of increased mortality risk in ART-treated patients followed up in the ANRS CO8 APROCO-COPILOTE cohort. METHODS The cohort enrolled 1,281 patients initiating a protease inhibitor-based regimen in 1997-1999. Clinical/laboratory data were collected every 4 months. Self-administered questionnaires collected psycho-social/behavioural characteristics at enrolment (month [M] 0), M4 and every 8-12 months thereafter. A multiple correspondence analysis using education, employment and housing indicators helped construct a composite indicator measuring social vulnerability. The outcome studied was all-cause deaths occurring after M4. The relationship between social vulnerability and mortality, after adjustment for other predictors, was studied using a shared-frailty Cox model, taking into account informative study dropout. RESULTS Over a median (IQR) follow-up of 7.9 (3.0-11.2) years, 121 deaths occurred among 1,057 eligible patients, corresponding to a mortality rate (95% CI) of 1.64 (1.37, 1.96)/100 person-years. Leading causes of death were non-AIDS defining cancers (n=26), AIDS (n=23) and cardiovascular diseases (n=12). Social vulnerability (HR [95% CI] =1.2 [1.0, 1.5]) was associated with increased mortality risk, after adjustment for other known behavioural and bio-medical predictors. CONCLUSIONS Social vulnerability remains a major mortality predictor in ART-treated patients. A real need exists for innovative interventions targeting individuals cumulating several sources of social vulnerability, to ensure that social inequalities do not continue to lead to higher mortality.
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Viremia copy-years as a predictive marker of all-cause mortality in HIV-1-infected patients initiating a protease inhibitor-containing antiretroviral treatment. J Acquir Immune Defic Syndr 2015; 68:204-8. [PMID: 25590273 DOI: 10.1097/qai.0000000000000416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Viremia copy-years (VCY) has been reported as a short-term predictor of mortality. We evaluated the association of this parameter with 10-year outcome within the APROCO-COPILOTE cohort. METHODS Prospective data from 1281 HIV-1-infected patients who started a first protease inhibitor-containing regimen in 1997-1999 were analyzed. Patients with baseline plasma viral load (pVL) > 500 copies per milliliter and at least 2 pVL measures from the eighth month of follow-up were selected. VCY was calculated individually over the follow-up as the area under the pVL curve. Multivariate Cox models analyzed the relation between all-cause mortality and the following variables: age, sex, geographical origin, transmission group, HIV infection duration, ART-naive, pVL at baseline, time-dependent CD4 count, and VCY. RESULTS Nine hundred seventy-nine patients were followed up for a median of 10 years (interquartile range: 5-11.5). At baseline, median (interquartile range) values for duration of HIV infection, pVL, and CD4 cell count were 43 (4-95) months, 4.6 (3.9-5.2) log10 copies per milliliter, and 278 (125-416) cells per cubic millimeter, respectively. At censoring date, 77 patients (8%) had died. VCY >1.4 log10 copies × yrs/mL was an independent predictor of death (hazard ratio: 2.0; 95% confidence interval: 1.2 to 3.5), which was no longer the case after adjustment for the latest pVL value [risk ratio (RR): 1.2 for 1 additional log10 copies per milliliter; 95% confidence interval: 1.1 to 1.4]. CONCLUSIONS VCY was associated with mortality in HIV-infected patients under combined antiretroviral therapy but did not overweigh the predictive value of the latest pVL. VCY might be more useful as a marker of persistent viral replication than for routine clinical care.
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Suzan-Monti M, Blanche J, Boyer S, Kouanfack C, Delaporte E, Bonono RC, Carrieri PM, Protopopescu C, Laurent C, Spire B. Benefits of task-shifting HIV care to nurses in terms of health-related quality of life in patients initiating antiretroviral therapy in rural district hospitals in Cameroon [Stratall Agence Nationale de Recherche sur le SIDA (ANRS) 12110/Ensemble pour une Solidarité Thérapeutique Hospitalière en Réseau (ESTHER) substudy]. HIV Med 2015; 16:307-18. [PMID: 25721267 DOI: 10.1111/hiv.12213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The World Health Organization (WHO) recommends task-shifting HIV care to nurses in low-resource settings with limited numbers of physicians. However, the effect of such task-shifting on the health-related quality of life (HRQL) of people living with HIV (PLHIV) has seldom been evaluated. We aimed to investigate the effect of task-shifting HIV care to nurses on HRQL outcomes in PLHIV initiating antiretroviral therapy (ART) in rural district hospitals in Cameroon. METHODS Outcomes in PLHIV were longitudinally collected in the 2006-2010 Stratall trial. PLHIV were followed up for 24 months by nurses and/or physicians. Six HRQL dimensions were assessed during face-to-face interviews using the WHO Quality of Life (WHOQOL)-HIV BREF scale: physical health; psychological health; independence level; social relationships; environment; and spirituality/religion/personal beliefs. The degree of task-shifting was estimated using a consultant ratio (i.e. the ratio of nurse-led to physician-led visits). The effect of task-shifting and other potential correlates on HRQL dimensions was explored using a Heckman two-stage approach based on linear mixed models to adjust for the potential bias caused by missing data in the outcomes. RESULTS Of 1424 visits in 440 PLHIV (70.5% female; median age 36 years; median CD4 count 188 cells/μL at enrolment), 423 (29.7%) were task-shifted to nurses. After multiple adjustment, task-shifting was associated with higher HRQL level for four dimensions: physical health [coefficient 0.7; 95% confidence interval (CI) 0.1-1.2; P = 0.01], psychological health (coefficient 0.5; 95% CI 0.0-1.0; P = 0.05), independence level (coefficient 0.6; 95% CI 0.1-1.1; P = 0.01) and environment (coefficient 0.6; 95% CI 0.1-1.0; P = 0.02). CONCLUSIONS Task-shifting HIV care to nurses benefits the HRQL of PLHIV. Together with the previously demonstrated comparable clinical effectiveness of physician-based and nurse-based models of HIV care, our results support the WHO recommendation for task-shifting.
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Affiliation(s)
- M Suzan-Monti
- INSERM, UMR912 Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), 13006, Marseille, France; Aix Marseille University, UMR_S912, IRD, 13006, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006, Marseille, France
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de Boer IM, Prins JM, Sprangers MA, Smit C, Nieuwkerk PT. Self-Reported Symptoms Among HIV-lnfected Patients on Highly Active Antiretroviral Therapy in the ATHENA Cohort in The Netherlands. HIV CLINICAL TRIALS 2015; 12:161-70. [DOI: 10.1310/hct1203-161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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The Effect on Treatment Adherence of Administering Drugs as Fixed-Dose Combinations versus as Separate Pills: Systematic Review and Meta-Analysis. AIDS Res Treat 2014; 2014:967073. [PMID: 25276422 PMCID: PMC4168145 DOI: 10.1155/2014/967073] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 08/19/2014] [Indexed: 11/17/2022] Open
Abstract
Administering drugs as fixed-dose combinations (FDCs) versus the same active drugs administered as separate pills is assumed to enhance treatment adherence. We synthesized evidence from randomized controlled trials (RCTs) about the effect of FDCs versus separate pills on adherence. We searched PubMed for RCTs comparing a FDC with the same active drugs administered as separate pills, including a quantitative estimate of treatment adherence, without restriction to medical condition. The odds ratio (OR) of optimal adherence with FDCs versus separate pills was used as common effect size and aggregated into a pooled effect estimate using a random effect model with inverse variance weights. Out of 1258 articles screened, only six studies fulfilled inclusion criteria. Across medical conditions, administering drugs as FDC significantly increased the likelihood of optimal adherence (OR 1.33 (95% CI, 1.03-1.71)). Within subgroups of specific medical conditions, the favourable effect of FDCs on adherence was of borderline statistical significance for HIV infection only (OR 1.46 (95% CI, 1.00-2.13)). We observed a remarkable paucity of RCTs comparing the effect on adherence of administering drugs as FDC versus as separate pills. Administering drugs as FDC improved medication adherence. However, this conclusion is based on a limited number of RCTs only.
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Langebeek N, Gisolf EH, Reiss P, Vervoort SC, Hafsteinsdóttir TB, Richter C, Sprangers MAG, Nieuwkerk PT. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med 2014; 12:142. [PMID: 25145556 PMCID: PMC4148019 DOI: 10.1186/preaccept-1453408941291432] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/01/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence. METHODS We searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression. RESULTS In total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD = 0.603, P = 0.001), current substance use (SMD = -0.395, P = 0.001), concerns about ART (SMD = -0.388, P = 0.001), beliefs about the necessity/utility of ART (SMD = 0.357, P = 0.001), trust/satisfaction with the HIV care provider (SMD = 0.377, P = 0.001), depressive symptoms (SMD = -0.305, P = 0.001), stigma about HIV (SMD = -0.282, P = 0.001), and social support (SMD = 0.237, P = 0.001). Smaller but significant associations were observed for the following being prescribed a protease inhibitor-containing regimen (SMD = -0.196, P = 0.001), daily dosing frequency (SMD = -0.193, P = 0.001), financial constraints (SMD -0.187, P = 0.001) and pill burden (SMD = -0.124, P = 0.001). Higher trust/satisfaction with the HIV care provider, a lower daily dosing frequency, and fewer depressive symptoms were more strongly related with higher adherence in low and medium HDI countries than in high HDI countries. CONCLUSIONS These findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects.
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Affiliation(s)
- Nienke Langebeek
- />Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands
- />Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
| | - Elizabeth H Gisolf
- />Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands
| | - Peter Reiss
- />Division of Infectious Diseases, and Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
- />Stichting HIV Monitoring, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
| | - Sigrid C Vervoort
- />Department of Infectious Diseases, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX Netherlands
| | - Thóra B Hafsteinsdóttir
- />Department of Rehabilitation, Nursing Science and Sports medicine, University Medical Center, Heidelberglaan 100, Utrecht, 3584 CX Netherlands
| | - Clemens Richter
- />Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815 AD Netherlands
| | - Mirjam AG Sprangers
- />Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
| | - Pythia T Nieuwkerk
- />Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
- />Department of Medical Psychology (J3-219-1), Academic Medical Center, Amsterdam, 1100 DE Netherlands
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Langebeek N, Gisolf EH, Reiss P, Vervoort SC, Hafsteinsdóttir TB, Richter C, Sprangers MAG, Nieuwkerk PT. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med 2014. [PMID: 25145556 PMCID: PMC4148019 DOI: 10.1186/s12916-014-0142-1] [Citation(s) in RCA: 252] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence. Methods We searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression. Results In total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD = 0.603, P = 0.001), current substance use (SMD = -0.395, P = 0.001), concerns about ART (SMD = -0.388, P = 0.001), beliefs about the necessity/utility of ART (SMD = 0.357, P = 0.001), trust/satisfaction with the HIV care provider (SMD = 0.377, P = 0.001), depressive symptoms (SMD = -0.305, P = 0.001), stigma about HIV (SMD = -0.282, P = 0.001), and social support (SMD = 0.237, P = 0.001). Smaller but significant associations were observed for the following being prescribed a protease inhibitor-containing regimen (SMD = -0.196, P = 0.001), daily dosing frequency (SMD = -0.193, P = 0.001), financial constraints (SMD -0.187, P = 0.001) and pill burden (SMD = -0.124, P = 0.001). Higher trust/satisfaction with the HIV care provider, a lower daily dosing frequency, and fewer depressive symptoms were more strongly related with higher adherence in low and medium HDI countries than in high HDI countries. Conclusions These findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects. Electronic supplementary material The online version of this article (doi:10.1186/s12916-014-0142-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | - Pythia T Nieuwkerk
- Department of Medical Psychology, Academic Medical Center, Meibergdreef 9, Amsterdam 1105, AZ, Netherlands.
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Adefolalu AO, Nkosi ZZ, Olorunju SAS. Patterns of adherence to scheduling and dietary instructions among patients on antiretroviral therapy in Pretoria, South Africa. Trans R Soc Trop Med Hyg 2014; 108:582-8. [PMID: 25096293 DOI: 10.1093/trstmh/tru116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adherence in antiretroviral therapy (ART) is the extent to which the HIV-infected person's behavior corresponds to the prescribed medical advice in terms of using antiretroviral (ARV) drugs. Adherence includes acts such as following instructions regarding dietary or fluid restrictions and taking medications at the prescribed time. This study aimed to determine the extent to which persons on ART followed the scheduling and dietary instructions of their ARV drugs. METHODS This was a cross-sectional descriptive study among 232 adult HIV-infected persons on ART using the AIDS Clinical Trials Group questionnaire. RESULTS Based on self-reported adherence, 89.6% (208/232) of the participants reported complete adherence with regards to taking their prescribed medications. The specific dosing schedule of their ARV drugs was strictly followed by 47.4% (110/232) of the participants. Of the 146 patients with specific dietary instructions on how to take their ARVs, only 43.1% (63/146) followed them all of the time, 10.9% (16/146) never followed these instructions and 45.8% (67/146) partially followed these instructions. Participants who were unemployed were twice more likely to adhere to ART dosing schedules compared to others (OR=1.75; CI: 1.03-2.96; p=0.05). CONCLUSIONS Participants in this study were adherent to taking prescribed medications only. They were found to be non-adherent to instructions regarding dietary or fluid restrictions and medication prescription time.
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Affiliation(s)
- Adegoke O Adefolalu
- Department of Health Studies, University of South Africa, Pretoria, South Africa
| | - Zerish Z Nkosi
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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Evaluation of an immunoassay for determination of plasma efavirenz concentrations in resource-limited settings. J Int AIDS Soc 2014; 17:18979. [PMID: 24909561 PMCID: PMC4049128 DOI: 10.7448/ias.17.1.18979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 04/07/2014] [Accepted: 04/17/2014] [Indexed: 11/08/2022] Open
Abstract
Introduction Therapeutic drug monitoring (TDM) may improve antiretroviral efficacy through adjustment of individual drug administration. This could result in reduced toxicity, prevent drug resistance, and aid management of drug–drug interactions. However, most measurement methods are too costly to be implemented in resource-limited settings. This study evaluated a commercially available immunoassay for measurement of plasma efavirenz. Methods The immunoassay-based method was applied to measure efavirenz using a readily available Humastar 80 chemistry analyzer. We compared plasma efavirenz concentrations measured by the immunoassay with liquid chromatography tandem mass spectrometry (LC-MS/MS) (reference method) in 315 plasma samples collected from HIV patients on treatment. Concentrations were categorized as suboptimal<1 µg/ml, normal 1–4 µg/ml or high>4 µg/ml. Agreement between results of the methods was assessed via Bland-Altman plot and κ statistic values. Results The median Interquartile range (IQR) efavirenz concentration was 2.8 (1.9; 4.5) µg/ml measured by the LC–MS/MS method and 2.5 (1.8; 3.9) µg/ml by the immunoassay and the results were well correlated (ρ=0.94). The limits of agreement assessed by Bland–Altman plots were −2.54; 1.70 µg/ml. Although immunoassay underestimated high concentrations, it had good agreement for classification into low, normal or high concentrations (K=0.74). Conclusions The immunoassay is a feasible alternative to determine efavirenz in areas with limited resources. The assay provides a reasonable approximation of efavirenz concentration in the majority of samples with a tendency to underestimate high concentrations. Agreement between tests evaluated in this study was clinically satisfactory for identification of low, normal and high efavirenz concentrations.
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Factors associated with suboptimal adherence to antiretroviral therapy in Asia. J Int AIDS Soc 2014; 17:18911. [PMID: 24836775 PMCID: PMC4024656 DOI: 10.7448/ias.17.1.18911] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 02/26/2014] [Accepted: 04/07/2014] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Adherence to antiretroviral therapy (ART) plays an important role in treatment outcomes. It is crucial to identify factors influencing adherence in order to optimize treatment responses. The aim of this study was to assess the rates of, and factors associated with, suboptimal adherence (SubAdh) in the first 24 months of ART in an Asian HIV cohort. METHODS As part of a prospective resistance monitoring study, the TREAT Asia Studies to Evaluate Resistance Monitoring Study (TASER-M) collected patients' adherence based on the World Health Organization-validated Adherence Visual Analogue Scale. SubAdh was defined in two ways: (i) <100% and (ii) <95%. Follow-up time started from ART initiation and was censored at 24 months, loss to follow-up, death, treatment switch, or treatment cessation for >14 days. Time was divided into four intervals: 0-6, 6-12, 12-18 and 18-24 months. Factors associated with SubAdh were analysed using generalized estimating equations. RESULTS Out of 1316 patients, 32% ever reported <100% adherence and 17% ever reported <95%. Defining the outcome as SubAdh <100%, the rates of SubAdh for the four time intervals were 26%, 17%, 12% and 10%. Sites with an average of >2 assessments per patient per year had an odds ratio (OR)=0.7 (95% confidence interval (CI) (0.55 to 0.90), p=0.006), compared to sites with ≤2 assessments per patient per year. Compared to heterosexual exposure, SubAdh was higher in injecting drug users (IDUs) (OR=1.92, 95% CI (1.23 to 3.00), p=0.004) and lower in homosexual exposure (OR=0.52, 95% CI (0.38 to 0.71), p<0.001). Patients taking a nucleoside transcriptase inhibitor and protease inhibitor (NRTI+PI) combination were less likely to report adherence <100% (OR=0.36, 95% CI (0.20 to 0.67), p=0.001) compared to patients taking an NRTI and non-nucleoside transcriptase inhibitor (NRTI+NNRTI) combination. SubAdh decreased with increasing time on ART (all p<0.001). Similar associations were found with adherence <95% as the outcome. CONCLUSIONS We found that SubAdh, defined as either <100% and <95%, was associated with mode of HIV exposure, ART regimen, time on ART and frequency of adherence measurement. The more frequently sites assessed patients, the lower the SubAdh, possibly reflecting site resourcing for patient counselling. Although social desirability bias could not be excluded, a greater emphasis on more frequent adherence counselling immediately following ART initiation and through the first six months may be valuable in promoting treatment and programme retention.
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The Complex Nature of Adherence in the Management of HIV/AIDS as a Chronic Medical Condition. Diseases 2013. [DOI: 10.3390/diseases1010018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lost or just not following up: public health effort to re-engage HIV-infected persons lost to follow-up into HIV medical care. AIDS 2013; 27:2271-9. [PMID: 23669157 DOI: 10.1097/qad.0b013e328362fdde] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Locate persons living with HIV (PLWH) presumed lost to follow-up (LTFU), and assist them with partner services and linkage to HIV-related care. DESIGN Locate and facilitate re-engagement in care for PLWH-LTFU in New York City (NYC), with longitudinal follow-up using HIV surveillance registry. SETTINGS HIV care facilities and communities in NYC. PATIENTS PLWH, reported in the NYC HIV surveillance registry, who had a NYC care provider and residential address at last report in the registry. Presumed-LTFU was defined as having no CD4+ or viral load during the most recent 9 months during the study period July 2008-December 2010. INTERVENTION Case-workers conducted public health investigation to locate PLWH presumed-LTFU and offered them assistance with partner and linkage-to-care services. MAIN OUTCOME MEASURES Results of partner and linkage-to-care services, and reasons for LTFU. RESULTS From July 2008 to December 2010, 797 PLWH presumed-LTFU were prioritized for investigation; 14% were never located. Of the 689 located, 33% were current to care, 5% had moved or were incarcerated, 2% had died, and 59% (409) were verified to be LTFU. Once located, 77% (315/409) accepted clinic appointments, and 57% (232/409) returned to care. Among the 161 who provided reasons for LTFU, the most commonly reported was 'felt well' (41%). CONCLUSIONS Health department case-workers helped more than half PLWH-LTFU re-engage in HIV medical care. HIV prevention strategies must include efforts to re-engage PLWH-LTFU in care, for treatment consideration under current treatment guidelines to improve their clinical status and decrease transmission risk.
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Oser ML, Trafton JA, Lejuez CW, Bonn-Miller MO. Differential associations between perceived and objective measurement of distress tolerance in relation to antiretroviral treatment adherence and response among HIV-positive individuals. Behav Ther 2013; 44:432-42. [PMID: 23768670 DOI: 10.1016/j.beth.2013.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 02/27/2013] [Accepted: 03/27/2013] [Indexed: 11/15/2022]
Abstract
The present study sought to extend prior work, showing an association between self-reported distress tolerance and self-reported antiretroviral treatment (ART) adherence, by conducting a multimethod test of the association between distress tolerance and objective measures of ART adherence among a sample of 140 individuals (23.6% female) with human immunodeficiency virus (HIV). Findings indicated that, after accounting for negative affectivity and ART side-effect severity, distress tolerance was significantly associated with pill count adherence as well as viral load. Specifically, a differential association was observed whereby self-reported distress tolerance was associated with pill count adherence, whereas behavioral distress tolerance was associated with viral load. Importantly, no associations were observed between either measure of distress tolerance and CD4 count. Findings are discussed in terms of the importance of both behavioral and perceived distress tolerance assessment among patients with HIV as well as potential clinical implications related to the integration of distress tolerance-focused treatments into existing interventions for individuals with HIV.
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Affiliation(s)
- Megan L Oser
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02130, USA.
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Krastinova E, Seng R, Yeni P, Viard JP, Vittecoq D, Lascoux-Combe C, Fourn E, Pahlavan G, Delfraissy JF, Goujard C, Meyer L. Is clinical practice concordant with the changes in guidelines for antiretroviral therapy initiation during primary and chronic HIV-1 infection? The ANRS PRIMO and COPANA cohorts. PLoS One 2013; 8:e71473. [PMID: 23936509 PMCID: PMC3731276 DOI: 10.1371/journal.pone.0071473] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 06/29/2013] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Guidelines for initiating HIV treatment are regularly revised. We explored how physicians in France have applied these evolving guidelines for ART initiation over the last decade in two different situations: chronic (CHI) and primary HIV-1 infection (PHI), since specific recommendations for PHI are also provided in France. METHODS Data came from the ANRS PRIMO (1267 patients enrolled during PHI in 1996-2010) and COPANA (800 subjects enrolled at HIV diagnosis in 2004-2008) cohorts. We defined as guidelines-inconsistent during PHI and CHI, patients meeting criteria for ART initiation and not treated in the following month and during the next 6 months, respectively. RESULTS ART initiation during PHI dramatically decreased from 91% of patients in 1996-99 to 22% in 2007 and increased to 60% in 2010, following changes in recommendations. In 2007, however, after the CD4 count threshold was raised to 350 cells/mm(3) in 2006, only 55% of the patients with CD4≤350 were treated and 66% in 2008. During CHI, ART was more frequently initiated in patients who met the criteria at entry (96%) than during follow-up: 83% when recommendation to treat was 200 and 73% when it was 350 cells/mm(3). Independent risk factors for not being treated during CHI despite meeting the criteria were lower viral load, lower educational level, and poorer living conditions. CONCLUSION HIV ART initiation guidelines are largely followed by practitioners in France. What can still be improved, however, is time to treat when CD4 cell counts reach the threshold to treat. Risk factors for lack of timely treatment highlight the need to understand better how patients' living conditions and physicians' perceptions influence the decision to initiate treatment.
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Affiliation(s)
- Evguenia Krastinova
- INSERM, U1018, Epidemiology of HIV and STI; University Paris-Sud 11, Le Kremlin-Bicêtre, France.
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Lowther K, Simms V, Selman L, Sherr L, Gwyther L, Kariuki H, Ahmed A, Ali Z, Jenkins R, Higginson IJ, Harding R. Treatment outcomes in palliative care: the TOPCare study. A mixed methods phase III randomised controlled trial to assess the effectiveness of a nurse-led palliative care intervention for HIV positive patients on antiretroviral therapy. BMC Infect Dis 2012; 12:288. [PMID: 23130740 PMCID: PMC3538672 DOI: 10.1186/1471-2334-12-288] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 10/18/2012] [Indexed: 12/03/2022] Open
Abstract
Background Patients with HIV/AIDS on Antiretroviral Therapy (ART) suffer from physical, psychological and spiritual problems. Despite international policy explicitly stating that a multidimensional approach such as palliative care should be delivered throughout the disease trajectory and alongside treatment, the effectiveness of this approach has not been tested in ART-experienced populations. Methods/design This mixed methods study uses a Randomised Controlled Trial (RCT) to test the null hypothesis that receipt of palliative care in addition to standard HIV care does not affect pain compared to standard care alone. An additional qualitative component will explore the mechanism of action and participant experience. The sample size is designed to detect a statistically significant decrease in reported pain, determined by a two tailed test and a p value of ≤0.05. Recruited patients will be adults on ART for more than one month, who report significant pain or symptoms which have lasted for more than two weeks (as measured by the African Palliative Care Association (APCA) African Palliative Outcome Scale (POS)). The intervention under trial is palliative care delivered by an existing HIV facility nurse trained to a set standard. Following an initial pilot the study will be delivered in two African countries, using two parallel independent Phase III clinical RCTs. Qualitative data will be collected from semi structured interviews and documentation from clinical encounters, to explore the experience of receiving palliative care in this context. Discussion The data provided by this study will provide evidence to inform the improvement of outcomes for people living with HIV and on ART in Africa. ClinicalTrials.gov Identifier: NCT01608802
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Affiliation(s)
- Keira Lowther
- Cicely Saunders Institute, Department of Palliative Care and Rehabilitation, Kings College London, London, UK.
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Nokes K, Johnson MO, Webel A, Rose CD, Phillips JC, Sullivan K, Tyer-Viola L, Rivero-Méndez M, Nicholas P, Kemppainen J, Sefcik E, Chen WT, Brion J, Eller L, Kirksey K, Wantland D, Portillo C, Corless IB, Voss J, Iipinge S, Spellmann M, Holzemer WL. Focus on increasing treatment self-efficacy to improve human immunodeficiency virus treatment adherence. J Nurs Scholarsh 2012; 44:403-10. [PMID: 23121723 DOI: 10.1111/j.1547-5069.2012.01476.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE Human immunodeficiency virus (HIV) treatment self-efficacy is the confidence held by an individual in her or his ability to follow treatment recommendations, including specific HIV care such as initiating and adhering to antiretroviral therapy (ART). The purpose of this study was to explore the potential mediating role of treatment adherence self-efficacy in the relationships between Social Cognitive Theory constructs and self- reported ART adherence. DESIGN Cross-sectional and descriptive. The study was conducted between 2009 and 2011 and included 1,414 participants who lived in the United States or Puerto Rico and were taking antiretroviral medications. METHODS Social cognitive constructs were tested specifically: behaviors (three adherence measures each consisting of one item about adherence at 3-day and 30-day along with the adherence rating scale), cognitive or personal factors (the Center for Epidemiology Studies Depression Scale to assess for depressive symptoms, the 12-Item Short Form Health Survey (SF-12) to assess physical functioning, one item about physical condition, one item about comorbidity), environmental influences (the Social Capital Scale, one item about social support), and treatment self-efficacy (HIV Adherence Self-Efficacy Scale). Analysis included descriptive statistics and regression. RESULTS The average participant was 47 years old, male, and a racial or ethnic minority, had an education of high school or less, had barely adequate or totally inadequate income, did not work, had health insurance, and was living with HIV/acquired immunodeficiency syndrome for 15 years. The model provided support for adherence self-efficacy as a robust predictor of ART adherence behavior, serving a partial mediating role between environmental influences and cognitive or personal factors. CONCLUSIONS Although other factors such as depressive symptoms and lack of social capital impact adherence to ART, nurses can focus on increasing treatment self-efficacy through diverse interactional strategies using principles of adult learning and strategies to improve health literacy. CLINICAL RELEVANCE Adherence to ART reduces the viral load thereby decreasing morbidity and mortality and risk of transmission to uninfected persons. Nurses need to use a variety of strategies to increase treatment self-efficacy.
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Affiliation(s)
- Kathleen Nokes
- Hunter College, CUNY, Hunter Bellevue School of Nursing, New York, NY 10010, USA.
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Springer SA, Dushaj A, Azar MM. The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: a systematic review. AIDS Behav 2012; 16:2119-43. [PMID: 22644066 PMCID: PMC3481055 DOI: 10.1007/s10461-012-0212-3] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This is a systematic review of eighty-two published studies investigating the impact of DSM-IV mental disorders on combination antiretroviral therapy (cART) adherence and persistence among persons living with HIV/AIDS (PLWHA). Sixty-two articles examined depression, with 58 % (N = 32/62) finding lower cART adherence and persistence. Seventeen articles examined one or more anxiety disorders, with the majority finding no association with cART adherence or persistence. Eighty percent of the studies that evaluated the impact of psychotic (N = 3), bipolar (N = 5) and personality disorders (N = 2) on cART adherence and persistence also found no association. Seven out of the nine studies (78 %) evaluating the impact of antidepressant treatment (ADT) on cART adherence found improvement. Adherence and depression measurements varied significantly in studies; common research measurements would improve data harmonization. More research specifically addressing the impact of other mental disorders besides depression on cART adherence and RCTs evaluating ADT on cART adherence are also needed.
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Affiliation(s)
- Sandra A Springer
- Yale AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06511, USA.
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Peterson K, van Griensven J, Huis in 't Veld D, Colebunders R. Interventions to reduce mortality in sub-Saharan Africa among HIV-infected adults not yet on antiretroviral therapy. Expert Rev Anti Infect Ther 2012; 10:43-50. [PMID: 22149613 DOI: 10.1586/eri.11.151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Where antiretroviral therapy is available, the primary source of mortality among HIV-infected people is the delay in starting treatment. Many of these delays occur in the context of care and are modifiable through changes in the protocols followed by healthcare providers for HIV testing, staging and preparation of patients for antiretroviral therapy. A number of potential evidence-based interventions are discussed in the context of sub-Saharan Africa. Included are decentralizing services, initiating counseling on antiretroviral therapy without delay, tracing patients that miss appointments, protecting patient confidentiality, reducing user fees, and providing point-of-care tests for CD4 cell counts, cryptococcal antigen, and for the diagnosis of TB.
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Affiliation(s)
- Kevin Peterson
- Institute for Tropical Medicine, Nationalestraat 155, 2000 Antwerpen, Belgium.
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Sumari-de Boer IM, Sprangers MAG, Prins JM, Nieuwkerk PT. HIV stigma and depressive symptoms are related to adherence and virological response to antiretroviral treatment among immigrant and indigenous HIV infected patients. AIDS Behav 2012; 16:1681-9. [PMID: 22198315 PMCID: PMC3401302 DOI: 10.1007/s10461-011-0112-y] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We compared adherence to cART and virological response between indigenous and immigrant HIV-infected patients in the Netherlands, and investigated if a possible difference was related to a difference in the psychosocial variables: HIV-stigma, quality-of-life, depression and beliefs about medications. Psychosocial variables were assessed using validated questionnaires administered during a face-to-face interview. Adherence was assessed trough pharmacy-refill monitoring. We assessed associations between psychosocial variables and non-adherence and having detectable plasma viral load using logistic regression analyses. Two-hundred-two patients participated of whom 112 (55%) were immigrants. Viral load was detectable in 6% of indigenous patients and in 15% of the immigrants (P < 0.01). In multivariate analyses, higher HIV-stigma and prior virological failure were associated with non-adherence, and depressive symptoms, prior virological failure and non-adherence with detectable viral load. Our findings suggest that HIV-stigma and depressive symptoms may be targets for interventions aimed at improving adherence and virological response among indigenous and immigrant HIV-infected patients.
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Wasti SP, Simkhada P, Randall J, Freeman JV, van Teijlingen E. Factors influencing adherence to antiretroviral treatment in Nepal: a mixed-methods study. PLoS One 2012; 7:e35547. [PMID: 22563464 PMCID: PMC3341373 DOI: 10.1371/journal.pone.0035547] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 03/21/2012] [Indexed: 11/25/2022] Open
Abstract
Background Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Maintaining optimal adherence to antiretroviral drugs is essential for HIV infection management. This study aimed to understand the factors influencing adherence amongst ART-prescribed patients and care providers in Nepal. Methods A cross-sectional mixed-methods study surveying 330 ART-prescribed patients and 34 in-depth interviews with three different types of stakeholders: patients, care providers, and key people at policy level. Adherence was assessed through survey self-reporting and during the interviews. A multivariate logistic regression model was used to identify factors associated with adherence, supplemented with a thematic analysis of the interview transcripts. Results A total of 282 (85.5%) respondents reported complete adherence, i.e. no missed doses in the four-weeks prior to interview. Major factors influencing adherence were: non-disclosure of HIV status (OR = 17.99, p = 0.014); alcohol use (OR = 12.89, p = <0.001), being female (OR = 6.91, p = 0.001), being illiterate (OR = 4.58, p = 0.015), side-effects (OR = 6.04, p = 0.025), ART started ≤24 months (OR = 3.18, p = 0.009), travel time to hospital >1 hour (OR = 2.84, p = 0.035). Similarly, lack of knowledge and negative perception towards ART medications also significantly affected non-adherence. Transport costs (for repeat prescription), followed by pills running out, not wanting others to notice, side-effects, and being busy were the most common reasons for non-adherence. The interviews also revealed religious or ritual obstacles, stigma and discrimination, ART-associated costs, transport problems, lack of support, and side-effects as contributing to non-adherence. Conclusion Improving adherence requires a supportive environment; accessible treatment; clear instructions about regimens; and regimens tailored to individual patients’ lifestyles. Healthcare workers should address some of the practical and cultural issues around ART medicine whilst policy-makers should develop appropriate social policy to promote adherence among ART-prescribed patients.
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Affiliation(s)
- Sharada P Wasti
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom.
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