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Oginni OA, Adelola AI, Ogunbajo A, Opara OJ, Akanji M, Ibigbami OI, Afolabi OT, Akinsulore A, Mapayi BM, Mosaku SK. Antiretroviral therapy non-adherence and its association with psychosocial factors in Nigeria: comparative study of sexual minority and heterosexual men living with HIV. AIDS Care 2024:1-13. [PMID: 38869985 DOI: 10.1080/09540121.2024.2366511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/03/2024] [Indexed: 06/15/2024]
Abstract
Sexual minority men (gay, bisexual and other men who have sex with men; SMM) in Nigeria are disproportionately affected by HIV compared to heterosexual men. There is a dearth of research on the correlates of antiretroviral therapy (ART) non-adherence and correlates in both groups. The current study examined the associations of ART non-adherence with sociodemographic and psychosocial characteristics among a sample of Nigerian heterosexual and SMM. Between March and September 2014, we surveyed 120 SMM and 108 heterosexual men receiving ART in Lagos and Abuja, Nigeria. We specified univariate and multivariable linear regression models to examine correlates of ART non-adherence. We found that 50.8% and 29.6% of sexual minority and heterosexual men respectively self-reported ART non-adherence which was significantly associated with psychosocial factors such as stigma, depressive symptoms, and suicidality. Mental health care and psychosocial support should be incorporated into routine HIV care for Nigerian SMM living with HIV.
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Affiliation(s)
- O A Oginni
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - A I Adelola
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | - O J Opara
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - O I Ibigbami
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - O T Afolabi
- Department of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - A Akinsulore
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - B M Mapayi
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - S K Mosaku
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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Dorcélus L, Bernard J, Georgery C, Vanessa C. Factors associated with antiretroviral therapy adherence among people living with HIV in Haiti: a cross-sectional study. AIDS Res Ther 2021; 18:81. [PMID: 34727943 PMCID: PMC8565028 DOI: 10.1186/s12981-021-00405-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Socioeconomic, demographic and clinical factors can affect adherence to treatment among people living with HIV (PLH) and potentially have an impact on their prognosis and survival. The main objective of this study was to assess these factors as potential barriers to adherence among patients receiving care in central Haiti. METHODS A cross-sectional study was conducted among PLH receiving antiretroviral therapy (ART) at the TB/HIV clinic at St. Therese Hospital in Hinche, Haiti. A total of 426 potential participants were approached during their follow-up visits from June to August 2019, of whom 411 participated in the study. After giving informed consent, study participants completed a structured interview that included the Self-Report Item Scale (SRIS), a standard measure, to assess adherence. Socio-demographic, economic and clinical factors were assessed for their association with adherence. RESULTS The 411 participating patients represented 39% of the patient population at the TB/HIV clinic during the timeframe of the study. The mean age was 43.7 years (range: 19-80), 65.5% were female and 78.1% had only achieved a primary level of schooling. Nearly 78% had received ART for less than 10 years, 3.41% reported having poor adherence and 28% less than excellent adherence. Factors related to poor adherence in bivariate analysis were age less than 40 years (OR: 6.32, 95% CI 2.04-10.58, p < 0.01) and inability to meet basic needs (OR: 2.70, 95% CI 1.04-7.0, p = 0.03). CONCLUSIONS To improve medication adherence, the hospital should strengthen patient counselling of younger recipients of ART and provide financial assistance and other social service interventions. Studies should be implemented in other HIV management centers in Haiti and similar contexts to examine barriers to ART adherence with the goal of improving prognosis and survival in the long-term among PLH in resource-limited setting.
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Affiliation(s)
| | - Joseph Bernard
- Université Notre-Dame d'Haïti, Rue Sapotille #4, Port-au-Prince, Haïti
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Mendicino CCP, Moodie EEM, Guimarães MDC, Pádua CAMD. Immune recovery after antiretroviral therapy initiation: a challenge for people living with HIV in Brazil. CAD SAUDE PUBLICA 2021; 37:e00143520. [PMID: 34669770 DOI: 10.1590/0102-311x00143520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 12/17/2020] [Indexed: 11/21/2022] Open
Abstract
Immune recovery reflects health conditions. Our goal was to estimate the time it takes to achieve immune recovery and its associated factors, in people living with HIV (PLHIV), after antiretroviral therapy (ART) initiation. A historical cohort study was performed among PLHIV (> 18 years-old) in Minas Gerais State, Brazil, using data from healthcare databases. Patients initiating ART between 2009-2018, with T-CD4+ lymphocytes and viral load recorded before and after antiretroviral therapy were included. The outcome is achievement of immune recovery, defined as the first T-CD4+ > 500 cells/µL after ART initiation. Explanatory variables were age, gender, place of residence, year of ART initiation, baseline viral load and T-CD4+, viral load status, and adherence to ART at follow-up. Descriptive analysis, cumulative, and person-time incidences of immune recovery were estimated. Median-time to immune recovery was estimated using Kaplan-Meier method. Factors associated with immune recovery were assessed by Cox regression. Among 26,430 PLHIV, 8,014 (30%) were eligible. Most were male (67%), mean age 38.7 years, resided in non-central region, median-baseline T-CD4+ = 228 cells/µL (< 200 cells/µL = 43%) and viral load median-baseline = 4.7 log10 copies/mL (detectable viral load = 99%). Follow-up time = 15,872 person-years. Cumulative and incidence rate were 58% (95%CI: 57-58) (n = 4,678) and 29.47 cases/100 person-years, respectively. Median-time to immune recovery was of 22.8 months (95%CI: 21.9-24.0). Women living with HIV, younger than 38 years of age, with T-CD4+ baseline > 200 cells/µL, detectable viral load (baseline), antiretroviral therapy-adherence and undetectable viral load (follow-up) were independently associated with immune recovery. Time to immune recovery remains long and depends on early treatment and antiretroviral therapy-adherence.
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Affiliation(s)
- Cássia C P Mendicino
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Hussein M, Dibaba B, Wondu Y. Factors Influencing Effectiveness of Peer Education Against Nonadherence to Antiretroviral Therapy Among Adult People Living with HIV/AIDS: A Pre-Post Intervention Study in Arsi Zone, Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:1-7. [PMID: 32021482 PMCID: PMC6957001 DOI: 10.2147/hiv.s228330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/20/2019] [Indexed: 11/23/2022]
Abstract
Background Nonadherence to antiretroviral therapy (ART) among people with HIV/AIDS can lead to drug resistance and death. Different studies have defined nonadherence, and it denotes at least one missed dose of ART within 28 days. One of the strategies to prevent nonadherence to ART could be peer education. However, published studies which test out whether or not peer education is effective for prevention of nonadherence to ART among adults living with HIV were not available. Moreover, published studies on factors discussing the success of peer education against nonadherence to ART were not available, so we conducted this study. Objectives To determine effectiveness of peer education against nonadherence to ART and identify factors influencing the effectiveness of peer education for prevention of nonadherence to ART among people living with HIV/AIDS in Arsi zone, Ethiopia. Methods An institution based pre-post intervention study was conducted. The intervention was giving peer education for three months. Frequencies and percentages were used to describe the data. Binary and multivariate logistic regressions were used to assess the variables. Results The data was collected from 355 and 319 people with HIV/AIDS at pre- and post-intervention stages, respectively. Experiencing an ART side effect, reminder to take ART, gender, marital status and monthly income were associated with nonadherence. More study participants who had not useda reminder to take ART service missed at least one dose of ART when compared to those who used a reminder to take ART service (adjusted odds ratio (AOR) =6.21; 95% CI=2.12–18.20). Conclusion Experiencing a side effect of ART influenced effectiveness of peer education negatively while using reminder to take ART influenced effectiveness positively. Peer education is effective for reduction of nonadherence to ART if it is used with reminder to take ART. This study can be a base for further studies that should be conducted in various areas, since peer education can be influenced by sociodemographic and economic factors.
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Affiliation(s)
- Mohammed Hussein
- Department of Pharmacy, College of Health Sciences, Arsi University, Asella, Oromia Regional State, Ethiopia
| | - Bekele Dibaba
- Department of Public Health, College of Health Sciences, Arsi University, Asella, Oromia Regional State, Ethiopia
| | - Yirga Wondu
- Department of Midwifery, College of Health Sciences, Arsi University, Asella, Oromia Regional State, Ethiopia
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Hiregoudar V, Bellara R, Goud TG. Proportion and Determinants of Adherence to Antiretroviral Therapy among HIV Positive People Registered Under ART Center in South India. Int J Prev Med 2019; 10:206. [PMID: 31921398 PMCID: PMC6941307 DOI: 10.4103/ijpvm.ijpvm_7_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/05/2018] [Indexed: 11/18/2022] Open
Abstract
Background: Antiretroviral therapy (ART) significantly delays the progression from HIV to AIDS. Adherence to ART is the second strongest predictor of progression to AIDS and death, after CD4 count. A very high level of adherence (≥95%) is required for ART to be effective on a long term and to prevent the emergence of resistant viral strains and prevent comorbidities. Methods: A case series study was undertaken at an ART center for a period of 6 months. Non-probability purposive sampling was adapted to select HIV-positive subjects aged >15 years on ART for more than 6 months. A predesigned semi-structured questionnaire was used to obtain the data. Treatment compliance was assessed by self-reported 1-week recall method. Results: A total of 536 HIV-positive people were interviewed, among which 315 (58.8%) of them were males and 214 (39.9%) were females. Nearly two third of the participants (359, 67.0%) reported ≥95% adherence to treatment. Personal commitments (51, 28.8%) and working time inconvenience (42, 23.7%) were the common reasons for less adherence. On bivariate analysis, married people (OR: 1.586, CI: 1.097-2.292), participants residing in rural area (OR: 1.628, CI: 1.130-2.345), participants not having side effects of drugs (OR: 5.324, CI: 3.491-8.181), participants equipped with better knowledge about ART (OR: 2.019, CI: 1.377-2.961), and participants having support of friends and family members (OR: 1.612, CI: 1.019-2.540) showed a higher level of adherence to ART. Conclusions: Demographic factors such as marital status, residing in rural area, and other personal factors like having good knowledge about ART, without side effects to drugs, and having support of friends and family members were found to show a high level of adherence to ART.
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Affiliation(s)
- Vandana Hiregoudar
- Department of Community Medicine, SDMCMS&H, Sattur, Dharwad, Karnataka, India
| | - Raghavendra Bellara
- Department of Community Medicine, SDMCMS&H, Sattur, Dharwad, Karnataka, India
| | - T Gangadhar Goud
- Department of Community Medicine, SDMCMS&H, Sattur, Dharwad, Karnataka, India
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Factors Associated With Early Virological Response in HIV-Infected Individuals Starting Antiretroviral Therapy in Brazil (2014-2015): Results From a Large HIV Surveillance Cohort. J Acquir Immune Defic Syndr 2019; 78:e19-e27. [PMID: 29557856 PMCID: PMC6023593 DOI: 10.1097/qai.0000000000001684] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To identify clinical, sociodemographic, and treatment-related factors associated with early virological response in HIV-infected adults starting antiretroviral treatment (ART) in Brazil in 2014–2015. Methods: Data from 4 information systems from the Brazilian AIDS Program were combined to create a historical cohort. Unconditional logistic regression models were used to assess the likelihood of not achieving viral load suppression (VLS), defined as having either a viral load (VL) count >200 copies per milliliter or an aids-related death recorded within 180 ± 90 days after treatment initiation. Results: Among 76,950 individuals, 64.8% were men; median age, CD4+, and VL counts were 34 years, 378 cells per micro liter, and 38,131 copies per milliliter, respectively, and 85.2% achieved VLS. In the multivariate analysis, some factors which increased the odds of non-VLS were as follows: lower CD4+ and higher VL counts, younger age, heterosexual or injection drug use groups (relative to men who have sex with men), lower educational level, black/brown race, higher pill burden, and higher dosing frequency. Regimens containing boosted protease inhibitors were similar to those containing nonnucleoside reverse transcriptase inhibitors and superior to those containing unboosted protease inhibitors (all P values <0.001). No difference was observed between patients with CD4+ counts 350–499 and 500+ cells per micro liter. Conclusions: Our findings support the decision made in Brazil in 2013 to recommend immediate initiation of ART regardless of clinical stage or CD4+. Several factors were found to be associated with poorer virologic outcomes and should be addressed to maximize ART adherence and success rates.
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Costa JDM, Torres TS, Coelho LE, Luz PM. Adherence to antiretroviral therapy for HIV/AIDS in Latin America and the Caribbean: Systematic review and meta-analysis. J Int AIDS Soc 2019; 21. [PMID: 29356390 PMCID: PMC5810329 DOI: 10.1002/jia2.25066] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/19/2017] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Optimal adherence to antiretroviral therapy is closely related with suppression of the HIV viral load in plasma, slowing disease progression and decreasing HIV transmission rates. Despite its importance, the estimated proportion of people living with HIV in Latin America and the Caribbean with optimal adherence has not yet been reported in a meta-analysis. Moreover, little is known of the factors leading to poor adherence which may be setting-specific. We present a pooled estimate of adherence to antiretroviral therapy (ART) of people living with HIV in Latin America and Caribbean, report the methods used to measure adherence and describe the factors associated with poor adherence among the selected studies. METHODS We electronically searched published studies up to July 2016 on the PubMed, Web of Science and Virtual Health Library (Latin America and the Caribbean Regional Portal); considering the following databases: MEDLINE, LILACS, PAHO and IBECS. Two independent reviewers selected and extracted data on ART adherence and study characteristics. Pooled estimate of adherence was derived using a random-effects model. Risk of bias in individual studies was assessed independently by two investigators using the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS). RESULTS AND DISCUSSION The meta-analysis included 53 studies published between 2005 and 2016, which analysed 22,603 people living with HIV in 25 Latin America and Caribbean countries. Overall adherence in Latin America and Caribbean was 70% (95% CI: 63-76; I2 = 98%), similar to levels identified by studies conducted in high-income regions. Self-report was the most frequently used method to measure adherence. Subgroup analysis showed that adherence was higher for the shortest recall time frame used, as well as in countries with lower income level, Gross National Income (GNI) per capita and Human Development Index (HDI). Studies reported diverse adherence barriers, such as alcohol and substance misuse, depression, unemployment and pill burden. CONCLUSIONS Our study suggests that adherence to ART in Latin America and Caribbean may be below the sufficient levels required for a successful long-term viral load suppression.
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Affiliation(s)
- Jessica de Mattos Costa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Thiago Silva Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Lara Esteves Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula Mendes Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Tadege M. Predictors associated with HIV/AIDS patients dropout from antiretroviral therapy at Mettu Karl Hospital, southwest Ethiopia. BMC Res Notes 2019; 12:232. [PMID: 30999924 PMCID: PMC6471805 DOI: 10.1186/s13104-019-4267-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/12/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the major risk factors of antiretroviral therapy dropout. The retrospective cohort research design was applied. 1512 HIV patients were included from Mettu Karl Hospital in Illubabor Zone, southwest part of Ethiopia from September 2005 to January 2018. Kaplan-Meier comparison and log-logistic regression accelerated failure time model were used. RESULTS From the log-logistic regression result, the risk of dropout for patients with primary education status was 10.58% greater as compared to illiterate (p < 0.0110). The probability of dropout for patients with marital status separated was about 16.82% higher than those patients with marital status divorced (p < 0.0070). Being merchant, farmer and daily labour had a greater risk of dropout as compared to a housewife. Most of the HIV/AIDS patients on ART were dropout in a short period due to patients separated marital status, primary education, CD4, being merchants, farmer and daily labour. Investigation on the cause of antiretroviral therapy dropout from a number of AIDS clinics in the country is highly appreciated.
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Affiliation(s)
- Melaku Tadege
- Department of Statistics, Injibara University, Injibara, Amhara, Ethiopia.
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Costa JDO, Pearson SA, Acurcio FDA, Bonolo PDF, Silveira MR, Ceccato MDGB. Health-related quality of life among HIV-infected patients initiating treatment in Brazil in the single-tablet regimen era. AIDS Care 2019; 31:572-581. [PMID: 30727749 DOI: 10.1080/09540121.2019.1576841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Health-related quality of life (HRQoL) is a multidimensional concept involving an individual's self-perception about how a disease or treatment impacts their daily life. In this study, we evaluated the HRQoL and factors associated with this outcome in 366 patients initiating combination Antiretroviral Therapy (cART) in Belo Horizonte, Brazil.We measured HRQoL using the EuroQoL-5D 3 level (EQ-5D) and the HIV instrument of the World Health Organization (WHOQOL-HIV BREF) and identified factors associated with HRQoL using multilevel linear regression. Participants had been on cART treatment a median of 65.5 days at the time the instruments were completed. The median HRQoL of patients on the single-tablet regimen containing efavirenz/ tenofovir/ lamivudine and the multi-tablet regimen containing dolutegravir and tenofovir/ lamivudine were high, with no significant difference between groups. Factors consistently associated with lower HRQoL were being single (unmarried), having a lower educational level, recent cigarette smoking, recent signs and symptoms of anxiety or depression, comorbid disease and the occurrence of adverse drug reactions. We observed high levels of HRQoL in cART-treated people and no differences between dolutegravir and efavirenz-based regimens. This study provides inputs to future economic analysis and identifies opportunities to increase the HRQoL of patients by targeting modifiable factors.
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Affiliation(s)
- Juliana de Oliveira Costa
- a Programa de Pós-Graduação em Saúde Pública - Faculdade de Medicina , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil.,b Centre for Big Data Research in Health , University of New South Wales , Sydney , Australia
| | - Sallie Anne Pearson
- b Centre for Big Data Research in Health , University of New South Wales , Sydney , Australia
| | - Francisco de Assis Acurcio
- a Programa de Pós-Graduação em Saúde Pública - Faculdade de Medicina , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil.,c Departamento de Farmácia Social - Faculdade de Farmácia , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Palmira de Fátima Bonolo
- d Departamento de Medicina Preventiva e Social - Faculdade de Medicina , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Micheline Rosa Silveira
- c Departamento de Farmácia Social - Faculdade de Farmácia , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Maria das Graças Braga Ceccato
- c Departamento de Farmácia Social - Faculdade de Farmácia , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
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Abdela J, Assefa A, Shamele S. Prevalence of Adverse Drug Reactions among Pediatric Patients on Antiretroviral Therapy in Selected Hospitals in Eastern Ethiopia: 8-Year Retrospective Cross-Sectional Study. J Int Assoc Provid AIDS Care 2019; 18:2325958218823208. [PMID: 30798673 PMCID: PMC6748515 DOI: 10.1177/2325958218823208] [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] [Received: 04/10/2018] [Revised: 11/30/2018] [Accepted: 12/10/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Antiretroviral-related adverse drug reactions (ADRs) are one of the leading causes of drug changes, poor adherence, and treatment failure. Therefore, this study was designed to assess the magnitude of ADR and associated factors among pediatric patients on antiretroviral therapy (ART). METHODS A retrospective cross-sectional study was conducted by reviewing the medical records of pediatric patients on ART at Hiwot Fana Specialized University Hospital and Jugal Hospital ART clinics. The collected data were coded, entered, and analyzed using SPSS, IBM version 16. The associations of selected categorical variables were done using binary logistic and multivariate logistic regression. RESULTS Of 186 medical records of pediatric patients on ART, 153 (82.25%) were reviewed. From the total medical records assessed, ADRs were observed in 23 (15.03%) of pediatric patients on ART, of which the most commonly encountered ADRs were anemia (34.8%) and followed by rash (17.4%). Most of ADRs were ranked as grade 3 (39.13%) and followed by grade 2 (30.4%) based on the degree of their severity. The likelihood of developing ADR was significantly associated with the regimen AZT/3TC/NVP (adjusted odds ratio: 6.420; 95% confidence interval: 1.056-39.018) relative to pediatric patients on D4T/3TC/NVP regimen. CONCLUSION This study indicated that few pediatric patients on ART experienced ADRs. Most of the observed ADRs were ranked as grade 2 and 3 in terms of their severity. Drug out of stock and ADRs were the 2 most common reasons for antiretroviral (ARV) drug regimen change that could affect patient's treatment outcome and limited future option.
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Affiliation(s)
- Jemal Abdela
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Anteneh Assefa
- Department of Pharmacy, College of Medical and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Sufiyan Shamele
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Costa JDO, Ceccato MDGB, Silveira MR, Bonolo PDF, Reis EA, Acurcio FDA. Effectiveness of antiretroviral therapy in the single-tablet regimen era. Rev Saude Publica 2018; 52:87. [PMID: 30462751 PMCID: PMC6280632 DOI: 10.11606/s1518-8787.2018052000399] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 01/10/2018] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of antiretroviral therapy and the associated factors according to the type of regimen used: Single Tablet Regimen or Multiple Tablet Regimen. METHODS Prospective cohort of 440 patients (male, 74.3%, median age, 36 years old) who initiated antiretroviral therapy between Jan/14 and Dec/15 at a referral service in Belo Horizonte. Efficacy was defined as viral suppression (viral load, VL < 50 copies/ml) and evaluated after six and twelve months of treatment. Sociodemographic, clinical and behavioral data were collected from clinical charts and from Information Systems. Multivariate analysis of overall effectiveness was performed by logistic regression. RESULTS Most patients initiated Multiple Tablet Regimen antiretroviral therapy (n = 255, 58%). At six months, overall viral suppression was 74.6%, being higher among patients who used Single Tablet Regimen (80.6%, p = 0.04). At twelve months, 83.2% of patients reached viral suppression, with no difference between groups (p = 0.93). Factors independently associated with viral suppression at six and twelve months varied, being negatively associated with effectiveness: VL ≥ 100,000 copies/ml, symptoms of AIDS, longer interval time between diagnosis and initiation of antiretroviral therapy, antiretroviral switching, smoking or current illicit drugs usage (p < 0.05). Factors positively associated with viral suppression included adherence to antiretroviral therapy and category of risk/exposure of men who have sex with men (p < 0.05). Reaching viral suppression at six months was the main predictor of effectiveness at one year (OR = 8.96 and p < 0.01). CONCLUSIONS Viral suppression was high and better results were achieved for patients who used Single Tablet Regimen regimens at six months. Clinical, behavioral, and antiretroviral therapy -related factors influence viral suppression and highlight the need for interventions to increase early diagnosis and initiation of antiretroviral therapy, patient’s adherence, and to reduce illicit drugs and cigarette smoking in this population.
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Affiliation(s)
- Juliana de Oliveira Costa
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brasil
| | - Maria das Graças Braga Ceccato
- Universidade Federal de Minas Gerais. Faculdade de Farmácia. Departamento de Farmácia Social. Belo Horizonte, MG, Brasil
| | - Micheline Rosa Silveira
- Universidade Federal de Minas Gerais. Faculdade de Farmácia. Departamento de Farmácia Social. Belo Horizonte, MG, Brasil
| | - Palmira de Fátima Bonolo
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Medicina Preventiva e Social. Belo Horizonte, MG, Brasil
| | - Edna Afonso Reis
- Universidade Federal de Minas Gerais. Instituto de Ciências Exatas. Departamento de Estatística. Belo Horizonte, MG, Brasil
| | - Francisco de Assis Acurcio
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brasil.,Universidade Federal de Minas Gerais. Faculdade de Farmácia. Departamento de Farmácia Social. Belo Horizonte, MG, Brasil
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Guimarães MDC, Carneiro M, Abreu DMXD, França EB. HIV/AIDS Mortality in Brazil, 2000-2015: Are there reasons for concern? REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 20Suppl 01:182-190. [PMID: 28658382 DOI: 10.1590/1980-5497201700050015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/10/2017] [Indexed: 11/21/2022] Open
Abstract
Introduction and objective: Mortality studies are essential for the monitoring of the HIV/AIDS epidemic. Quality and completeness of data from the mortality information system (SIM) require complementary approaches. Methods: Two sources of data were used to assess mortality trends due to HIV/AIDS in Brazil from 2000 and 2014/15: a) data from the SIM published by the Department of STDs, AIDS, and viral hepatitis, and b) Global Burden of Disease 2015 (GBD 2015) studies. Descriptive analyses were carried out and trends in relative reduction of age-adjusted mortality rates per 100,000 inhabitants were compared according to the two methods. Results: Overall, the magnitude of the mortality rates estimated by the GBD method, for Brazil and its Federative Units (FU), was greater than those obtained from the SIM. The relative reduction was higher for SIM data and there were shifts in the ranking according to the FUs. Between 2000 and 2014/15 there was an increase in the mortality rates for most of the FUs (78 and 88% according to the SIM and GBD, respectively). Conclusion: Data regarding mortality due to HIV/AIDS in Brazil should be of concern, regardless of the method used. Differences in magnitude, relative reductions, and ranking can be attributed to methodological differences, but the GBD is broader, with a higher capacity to capture incorrectly classified data and causes of death not registered or not coded as being due to HIV/AIDS. Alternative and complementary data sources can provide important information for HIV/AIDS public policies in Brazil.
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Affiliation(s)
- Mark Drew Crosland Guimarães
- Grupo de Pesquisas em Epidemiologia e Avaliação em Saúde, Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | - Mariângela Carneiro
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | - Daisy Maria Xavier de Abreu
- Grupo de Pesquisas em Epidemiologia e Avaliação em Saúde, Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | - Elisabeth Barboza França
- Grupo de Pesquisas em Epidemiologia e Avaliação em Saúde, Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
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Mendes JC, Bonolo PDF, Ceccato MDGB, Costa JDO, Reis AMM, Dos Santos H, Silveira MR. Adverse reactions associated with first-line regimens in patient initiating antiretroviral therapy. Eur J Clin Pharmacol 2018; 74:1077-1088. [PMID: 29740676 DOI: 10.1007/s00228-018-2472-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/25/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the prevalence of adverse drug reactions (ADR) and associated factors during the use of Highly Active Antiretroviral Therapy (HAART) in patients initiating treatment. METHODS This is a cross-sectional analysis of a prospective study conducted in three public referral services specialized in HIV/AIDS care in Belo Horizonte, Brazil. Self-reported ADR and explanatory variables were obtained from face-to-face interview and from Information Systems. Associated factors with ADR were evaluated by logistic regression in SPSS software v.22. RESULTS We included 399 patients, of which 85.5% reported at least one and 72.7% up to 5 ADRs after HAART initiation. Neurological reactions were the most frequent, with self-reported ADRs being distinct according to HAART regimen used. The global model showed higher chance of ADRs among females (OR = 3.52) and illicit drug users (OR = 2.28). Lower chance of ADRs was found for patients aged > 33 years (OR = 0.37), DTG/TDF/3TC users (OR = 0.41), and higher physical domain of quality of life (OR = 0.78). The model restricted to patients using the single-tablet regimen EFV/TDF/3TC showed lower ADRs among patients with CD4+ T lymphocyte count > 200 cells/mm3 (OR = 0.23) and higher independence domain of quality of life (OR = 0.74). The model restricted to DTG/TDF/3TC and to other regimens showed lower ADRs with higher physical domain of quality of life (OR = 0.74 and OR = 0.55, respectively). CONCLUSIONS The prevalence of self-reported ADRs to first-line antiretroviral regimens was high and patients using DTG/TDF/3TC had a smaller number of ADRs. In addition to HAART regimen, sociodemographic, clinical, and quality of life characteristics were associated with ADRs.
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Affiliation(s)
- Jullye Campos Mendes
- Faculdade de Farmácia, Universidade Federal de Minas Gerais-UFMG, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
| | - Palmira de Fátima Bonolo
- Faculdade de Medicina, Universidade Federal de Minas Gerais-UFMG, Avenida Professor Alfredo Balena 190, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Maria das Graças Braga Ceccato
- Faculdade de Farmácia, Universidade Federal de Minas Gerais-UFMG, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Juliana de Oliveira Costa
- Faculdade de Medicina, Universidade Federal de Minas Gerais-UFMG, Avenida Professor Alfredo Balena 190, Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Adriano Max Moreira Reis
- Faculdade de Farmácia, Universidade Federal de Minas Gerais-UFMG, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Henrique Dos Santos
- Instituto de Educação Continuada, Pontifícia Universidade Católica de Minas Gerais-PUC Minas, Rua Cláudio Manoel 1205, Funcionários, Belo Horizonte, Minas Gerais, 30140-100, Brazil
| | - Micheline Rosa Silveira
- Faculdade de Farmácia, Universidade Federal de Minas Gerais-UFMG, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
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de Pádua CM, Braga LP, Pinto Mendicino CC. Adverse reactions to antiretroviral therapy: a prevalent concern. REVISTA PANAMERICANA DE SALUD PUBLICA = PAN AMERICAN JOURNAL OF PUBLIC HEALTH 2017; 41:e84. [PMID: 31391821 PMCID: PMC6660853 DOI: 10.26633/rpsp.2017.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 01/09/2017] [Indexed: 12/17/2022]
Abstract
The risk–benefit ratio of antiretroviral therapy (ART) is usually considered favorable due to the urgent need to control the HIV/AIDS epidemic. Current studies have shown that combined ART (two or more drugs, from two different classes) is the most effective, with benefits that go beyond clinical management of the disease playing a crucial role in preventing HIV transmission. Therefore, early identification of HIV infection followed by immediate initiation of ART has been encouraged worldwide. However, the success of this strategy has been threatened by poor engagement of patients in HIV care, which may be related to drug harms. In addition, ART is required for the life course, creating the potential for adverse drug reactions (e.g., lipodystrophies). Therefore, adverse drug reactions are a prevalent concern among people living with HIV/AIDS, even in the current era of early initiation of ART (“early ART”), with most drugs considered much safer than those used in previous eras. Accurate diagnosis, recording, and reporting, followed up with proper management and prevention, and intensive surveillance, of new and known adverse reactions to ART, should be strongly encouraged as part of the care continuum.
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Affiliation(s)
- Cristiane Menezes de Pádua
- Department of Social Pharmacy, School of Pharmacy Universidade Federal de Minas Gerais Belo Horizonte, MG Brazil Department of Social Pharmacy, School of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Letícia Penna Braga
- Department of Social Pharmacy, School of Pharmacy Universidade Federal de Minas Gerais Belo Horizonte, MG Brazil Department of Social Pharmacy, School of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Cássia Cristina Pinto Mendicino
- Department of Social Pharmacy, School of Pharmacy Universidade Federal de Minas Gerais Belo Horizonte, MG Brazil Department of Social Pharmacy, School of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Baseline CD4 Count and Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis. J Acquir Immune Defic Syndr 2017; 73:514-521. [PMID: 27851712 DOI: 10.1097/qai.0000000000001092] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In light of recent changes to antiretroviral treatment (ART) guidelines of the World Health Organization and ongoing concerns about adherence with earlier initiation of ART, we conducted a systematic review of published literature to review the association between baseline (pre-ART initiation) CD4 count and ART adherence among adults enrolled in ART programs worldwide. METHODS We performed a systematic search of English language original studies published between January 1, 2004 and September 30, 2015 using Medline, Web of Science, LILACS, AIM, IMEMR, and WPIMR databases. We calculated the odds of being adherent at higher CD4 count compared with lower CD4 count according to study definitions and pooled data using random effects models. RESULTS Twenty-eight articles were included in the review and 18 in the meta-analysis. The odds of being adherent was marginally lower for patients in the higher CD4 count group (pooled odds ratio, 0.90; 95% confidence interval, 0.84 to 0.96); however, the majority of studies found no difference in the odds of adherence when comparing CD4 count strata. In analyses restricted to comparisons above and below a CD4 count of 500 cells per microliter, there was no difference in adherence (pooled odds ratio, 1.01; 95% confidence interval: 0.97 to 1.05). CONCLUSIONS This review was unable to find consistent evidence of differences in adherence according to baseline CD4 count. Although this is encouraging for the new recommendations to treat all HIV-positive individuals irrespective of CD4 count, there is a need for additional high-quality studies, particularly among adults initiating ART at higher CD4 cell counts.
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Betancur MN, Lins L, Oliveira IRD, Brites C. Quality of life, anxiety and depression in patients with HIV/AIDS who present poor adherence to antiretroviral therapy: a cross-sectional study in Salvador, Brazil. Braz J Infect Dis 2017; 21:507-514. [PMID: 28535397 PMCID: PMC9425484 DOI: 10.1016/j.bjid.2017.04.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/17/2017] [Accepted: 04/17/2017] [Indexed: 11/29/2022] Open
Abstract
The introduction of highly active antiretroviral therapy marked a major gain in efficacy of HIV/AIDS treatment and a reduction in morbidity and mortality of the infected patients. However, high levels of adherence are required to obtain virologic suppression. In Brazil, the policy of free and universal access to antiretroviral therapy has been in place since 1996, although there are reports of poor adherence. Objective To define the clinical, demographic and psychological characteristics, and quality of life of patients with HIV/AIDS who present poor adherence to highly active antiretroviral therapy. Methods This was a cross-sectional study. To be included in the study patients had to be 18 through 65 years old, diagnosed with HIV/AIDS, having the two previous viral loads above 500 copies, a surrogate for poor adherence to antiretrovirals. The following instruments were applied to all eligible patients: the sociodemographic questionnaire “Adherence Follow-up Questionnaire”, the Beck Depression Inventory (BDI-II), the Beck Anxiety Inventory (BAI), and the 36-Item Short Form Survey. Results 47 patients were evaluated, 70.2% were female, mean age of 41.9 years (±10.5), 46.8% were single, 51.1% self-reported adherence ≥95%, 46.8% mentioned depression as the main reason for not taking the medication, 59.5% presented symptoms of moderate to severe depression, and 44.7% presented symptoms of moderate to severe anxiety. Finally, regarding health-related quality of life these patients obtained low scores in all dimensions, physical component summary of 43.96 (±9.64) and mental component summary of 33.19 (±13.35). Conclusion The psychological component is considered to be fundamental in the management of HIV/AIDS patients. Psychoeducation should be conducted at the initial evaluation to reduce negative beliefs regarding antiretroviral therapy Assessment of anxiety and depression symptoms should be done throughout therapy as both psycological conditions are associated with patient adherence, success of treatment, and ultimately with patients’ quality of life.
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Affiliation(s)
- Mónica Narváez Betancur
- Universidade Federal da Bahia (UFBA) Programa de Pós-Graduação em Medicina e Saúde, Salvador, BA, Brazil
| | - Liliane Lins
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Medicina, Salvador, BA, Brazil
| | - Irismar Reis de Oliveira
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Medicina, Salvador, BA, Brazil
| | - Carlos Brites
- Universidade Federal da Bahia (UFBA) Programa de Pós-Graduação em Medicina e Saúde, Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Medicina, Salvador, BA, Brazil.
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17
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Brandt CP, Paulus DJ, Garza M, Lemaire C, Norton PJ, Zvolensky MJ. A Novel Integrated Cognitive-Behavioral Therapy for Anxiety and Medication Adherence Among Persons Living With HIV/AIDS. COGNITIVE AND BEHAVIORAL PRACTICE 2017; 25:105-118. [PMID: 29750006 DOI: 10.1016/j.cbpra.2017.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Persons living with HIV/AIDS (PLHIV) are able to live full lifespans after infection, however, rates of anxiety disorders among this population are elevated compared to national samples. Importantly, these anxiety symptoms and disorders have a negative effect on medication adherence, quality of life and other psychological disorders, such as depression. In order to reduce the impact of anxiety among PLHIV, a six-session transdiagnostic CBT-based treatment manual for anxiety among PLHIV named the HIV/Anxiety Management-Reduction Treatment (HAMRT) was developed and implemented. The current manuscript discusses the content of this manual as well as results from three cases examining the impact of HAMRT. Results indicated that HAMRT was effective in reducing symptoms of anxiety, anxiety sensitivity, depression, and negative affect among our sample. Additionally, results indicated that HAMRT was effective in increasing HIV medication adherence as well as quality of life. Results are discussed in terms of the potential utility of an anxiety-reduction therapy program aimed at increasing medication adherence among PLHIV.
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18
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Li H, Marley G, Ma W, Wei C, Lackey M, Ma Q, Renaud F, Vitoria M, Beanland R, Doherty M, Tucker JD. The Role of ARV Associated Adverse Drug Reactions in Influencing Adherence Among HIV-Infected Individuals: A Systematic Review and Qualitative Meta-Synthesis. AIDS Behav 2017; 21:341-351. [PMID: 27613645 PMCID: PMC5290204 DOI: 10.1007/s10461-016-1545-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Poor adherence remains a major barrier to achieving the clinical and public health benefits of antiretroviral drugs (ARVs). A systematic review and qualitative meta-synthesis was conduct to evaluate how ARV adverse drug reactions may influence ARV adherence. Thirty-nine articles were identified, and 33 reported that ARV adverse drug reactions decreased adherence and six studies found no influence. Visually noticeable adverse drug reactions and psychological adverse reactions were reported as more likely to cause non-adherence compared to other adverse drug reactions. Six studies reported a range of adverse reactions associated with EFV-containing regimens contributing to decreased adherence. Informing HIV-infected individuals about ARV adverse drug reactions prior to initiation, counselling about coping mechanisms, and experiencing the effectiveness of ARVs on wellbeing may improve ARV adherence.
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Affiliation(s)
- Haochu Li
- School of Public Health, Shandong University, Jinan, China.
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Gifty Marley
- School of Public Health, Shandong University, Jinan, China
| | - Wei Ma
- School of Public Health, Shandong University, Jinan, China
| | - Chongyi Wei
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Mellanye Lackey
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Qingyan Ma
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Marco Vitoria
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Rachel Beanland
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Joseph D Tucker
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- UNC Project-China, Guangdong Provincial Skin Diseases and STI Control, Number 2 Lujing Road, Guangzhou, 510095, China.
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Arruda MB, Campagnari F, de Almeida TB, Couto-Fernandez JC, Tanuri A, Cardoso CC. Single Nucleotide Polymorphisms in Cellular Drug Transporters Are Associated with Intolerance to Antiretroviral Therapy in Brazilian HIV-1 Positive Individuals. PLoS One 2016; 11:e0163170. [PMID: 27648838 PMCID: PMC5029869 DOI: 10.1371/journal.pone.0163170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/02/2016] [Indexed: 01/11/2023] Open
Abstract
Adverse reactions are the main cause of treatment discontinuation among HIV+ individuals. Genes related to drug absorption, distribution, metabolism and excretion (ADME) influence drug bioavailability and treatment response. We have investigated the association between single nucleotide polymorphisms (SNPs) in 29 ADME genes and intolerance to therapy in a case-control study including 764 individuals. Results showed that 15 SNPs were associated with intolerance to nucleoside and 11 to non-nucleoside reverse transcriptase inhibitors (NRTIs and NNRTIs), and 8 to protease inhibitors (PIs) containing regimens under alpha = 0.05. After Bonferroni adjustment, two associations remained statistically significant. SNP rs2712816, at SLCO2B1 was associated to intolerance to NRTIs (ORGA/AA = 2.37; p = 0.0001), while rs4148396, at ABCC2, conferred risk of intolerance to PIs containing regimens (ORCT/TT = 2.64; p = 0.00009). Accordingly, haplotypes carrying rs2712816A and rs4148396T alleles were also associated to risk of intolerance to NRTIs and PIs, respectively. Our data reinforce the role of drug transporters in response to HIV therapy and may contribute to a future development of personalized therapies.
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Affiliation(s)
- Mônica Barcellos Arruda
- Laboratório de Virologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Tailah Bernardo de Almeida
- Laboratório de Virologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Amilcar Tanuri
- Laboratório de Virologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Cynthia Chester Cardoso
- Laboratório de Virologia Molecular, Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
- * E-mail:
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Kimeu M, Burmen B, Audi B, Adega A, Owuor K, Arodi S, Bii D, Zielinski-Gutiérrez E. The relationship between adherence to clinic appointments and year-one mortality for newly enrolled HIV infected patients at a regional referral hospital in Western Kenya, January 2011-December 2012. AIDS Care 2015; 28:409-15. [PMID: 26572059 DOI: 10.1080/09540121.2015.1109587] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This retrospective cohort analysis was conducted to describe the association between adherence to clinic appointments and mortality, one year after enrollment into HIV care. We examined appointment-adherence for newly enrolled patients between January 2011 and December 2012 at a regional referral hospital in western Kenya. The outcomes of interest were patient default, risk factors for repeat default, and year-one risk of death. Of 582 enrolled patients, 258 (44%) were defaulters. GEE revealed that once having been defaulters, patients were significantly more likely to repeatedly default (OR 1.4; 95% CI 1.12-1.77), especially the unemployed (OR 1.43; 95% CI 1.07-1.91), smokers (OR 2.22; 95% CI 1.31-3.76), and those with no known disclosure (OR 2.17; 95% CI 1.42-3.3). Nineteen patients (3%) died during the follow-up period. Cox proportional hazards revealed that the risk of death was significantly higher among defaulters (HR 3.12; 95% CI 1.2-8.0) and increased proportionally to the rate of patient default; HR was 4.05 (95% CI1.38-11.81) and 4.98 (95% CI 1.45-17.09) for a cumulative of 4-60 and ≥60 days elapsed between all scheduled and actual clinic appointment dates, respectively. Risk factors for repeat default suggest a need to deliver targeted adherence programs.
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Affiliation(s)
- Muthusi Kimeu
- a Global Programs for Research and Training , University of California , San Francisco , Nairobi , Kenya
| | - Barbara Burmen
- b HIV Implementation Science and Services Kenya Medical Research Institute/Centers for Global Health Research (KEMRI,CGHR) , Kisumu , Kenya
| | - Beryl Audi
- b HIV Implementation Science and Services Kenya Medical Research Institute/Centers for Global Health Research (KEMRI,CGHR) , Kisumu , Kenya
| | - Anne Adega
- b HIV Implementation Science and Services Kenya Medical Research Institute/Centers for Global Health Research (KEMRI,CGHR) , Kisumu , Kenya
| | - Karen Owuor
- b HIV Implementation Science and Services Kenya Medical Research Institute/Centers for Global Health Research (KEMRI,CGHR) , Kisumu , Kenya
| | - Susan Arodi
- c HIV Comprehensive Care Centre , Jaramogi Oginga Odinga Teaching and Referral Hospital , Kisumu , Kenya
| | - Dennis Bii
- b HIV Implementation Science and Services Kenya Medical Research Institute/Centers for Global Health Research (KEMRI,CGHR) , Kisumu , Kenya
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Hoffmann M, MacCarthy S, Batson A, Crawford-Roberts A, Rasanathan J, Nunn A, Silva LA, Dourado I. Barriers along the care cascade of HIV-infected men in a large urban center of Brazil. AIDS Care 2015; 28:57-62. [PMID: 26291264 DOI: 10.1080/09540121.2015.1062462] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Global and national HIV/AIDS policies utilize the care cascade to emphasize the importance of continued engagement in HIV services from diagnosis to viral suppression. Several studies have documented barriers that men experience in accessing services at specific stages of care, but few have analyzed how these barriers operate along the care cascade. Brazil offers a unique setting for analyzing barriers to HIV care because it is a middle-income country with a large HIV epidemic and free, universal access to HIV/AIDS services. Semi-structured interviews were conducted in 2011 with HIV-infected men (n = 25) receiving care at the only HIV/AIDS state reference center in Salvador, Brazil, the third largest city in the country. Interviews were transcribed and coded for analysis. Researchers identified barriers to services along the care cascade: health service-related obstacles (poor-quality care, lengthy wait times, and drug supply problems); psychosocial and emotional challenges (fear of disclosure and difficulty accepting HIV diagnosis); indirect costs (transportation and absenteeism at work or school); low perceived risk of HIV; and toxicity and complexity of antiretroviral drug (ARV) regimens. The stages of the care cascade interrupted by each barrier were also identified. Most barriers affected multiple, and often all, stages of care, while toxicity and complexity of ARV regimens was only present at a single care stage. Efforts to eliminate more prevalent barriers have the potential to improve care continuity at multiple stages. Going forward, assessing the relative impact of barriers along one's entire care trajectory can help tailor improvements in service provision, facilitate achievement of viral suppression, and improve access to life-saving testing, treatment, and care.
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Affiliation(s)
- Michael Hoffmann
- a Brown University School of Public Health and the Miriam Hospital , 121 South Main St. Suite 810, Providence , RI 02912 , USA
| | - Sarah MacCarthy
- b RAND Corporation , 1776 Main Street, Santa Monica , CA 90407 , USA
| | - Ashley Batson
- a Brown University School of Public Health and the Miriam Hospital , 121 South Main St. Suite 810, Providence , RI 02912 , USA
| | - Ann Crawford-Roberts
- c Icahn School of Medicine at Mount Sinai , 1428 Madison Ave, New York , NY 10029 , USA
| | - Jennifer Rasanathan
- d Department of Family and Social Medicine , Montefiore Medical Center , 111 East 210th Street, Bronx , NY 10467 , USA
| | - Amy Nunn
- a Brown University School of Public Health and the Miriam Hospital , 121 South Main St. Suite 810, Providence , RI 02912 , USA
| | - Luis Augusto Silva
- e Institute of Collective Health, Federal University of Bahia , Rua Basilio da Gama, s/n - Campus Universitario Canela, Salvador , Bahia , Brazil
| | - Ines Dourado
- e Institute of Collective Health, Federal University of Bahia , Rua Basilio da Gama, s/n - Campus Universitario Canela, Salvador , Bahia , Brazil
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Puchalski Ritchie LM, Schull MJ, Martiniuk ALC, Barnsley J, Arenovich T, van Lettow M, Chan AK, Mills EJ, Makwakwa A, Zwarenstein M. A knowledge translation intervention to improve tuberculosis care and outcomes in Malawi: a pragmatic cluster randomized controlled trial. Implement Sci 2015; 10:38. [PMID: 25890186 PMCID: PMC4437452 DOI: 10.1186/s13012-015-0228-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 03/06/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Lay health workers (LHWs) play a pivotal role in addressing the high TB burden in Malawi. LHWs report lack of training to be a key barrier to their role as TB care providers. Given the cost of traditional off-site training, an alternative approach is needed. Our objective was to evaluate the effectiveness of a KT intervention tailored to LHWs needs. METHODS The study design is a pragmatic cluster randomized trial. The study was embedded within a larger trial, PALMPLUS, and compared three arms which included 28 health centers in Zomba district, Malawi. The control arm included 14 health centers randomized as controls in the larger trial and maintained as control sites. Seven of 14 PALMPLUS intervention sites were randomized to the LHW intervention (PALM/LHW intervention arm), and the remaining 7 PALMPLUS sites maintained as a PALM only arm. PALMPLUS intervention sites received an educational outreach program targeting mid-level health workers. LHW intervention sites received both the PALMPLUS intervention and the LHW intervention employing on-site peer-led educational outreach and a point-of-care tool tailored to LHWs identified needs. Control sites received no intervention. The main outcome measure is the proportion of treatment successes. RESULTS Among the 28 sites, there were 178 incident TB cases with 46/80 (0.58) successes in the control group, 44/68 (0.65) successes in the PALMPLUS group, and 21/30 (0.70) successes in the PALM/LHW intervention group. There was no significant effect of the intervention on treatment success in the univariate analysis adjusted for cluster randomization (p = 0.578) or multivariate analysis controlling for covariates with significant model effects (p = 0.760). The overall test of the intervention-arm by TB-type interaction approached but did not achieve significance (p = 0.056), with the interaction significant only in the control arm [RR of treatment success for pulmonary TB relative to non-pulmonary TB, 1.18, 95% CI 1.05-1.31]. CONCLUSIONS We found no significant treatment effect of our intervention. Given the identified trend for effectiveness and urgent need for low-cost approaches to LHW training, further evaluation of tailored KT strategies as a means of LHW training in Malawi and other LMICs is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT01356095 .
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Affiliation(s)
- Lisa M Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Emergency Medicine, University Health Network, Toronto General Hospital, RFE-GS-480, 200 Elizabeth St., Toronto, Ontario, M5G 2C4, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Michael J Schull
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Dignitas International, Toronto, Canada.
- Sunnybrook Health Sciences Center, Toronto, ON, Canada.
| | - Alexandra L C Martiniuk
- Dignitas International, Toronto, Canada.
- George Institute for Global Health, Sydney, Australia.
- The University of Sydney, Sydney, Australia.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Jan Barnsley
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Tamara Arenovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Monique van Lettow
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Dignitas International, Zomba, Malawi.
| | - Adrienne K Chan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Dignitas International, Toronto, Canada.
- Sunnybrook Health Sciences Center, Toronto, ON, Canada.
| | - Edward J Mills
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - Austine Makwakwa
- National TB Control Program, Ministry of Health, Lilongwe, Malawi.
| | - Merrick Zwarenstein
- Dignitas International, Toronto, Canada.
- Knowledge translation unit, Lung Institute, University of Cape Town, Cape Town, South Africa.
- Stellenbosch University Faculty of Health Sciences, Tygerberg, South Africa.
- Depart of Family Medicine, Western University, London, Ontario, Canada.
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Tsega B, Srikanth BA, Shewamene Z. Determinants of non-adherence to antiretroviral therapy in adult hospitalized patients, Northwest Ethiopia. Patient Prefer Adherence 2015; 9:373-80. [PMID: 25784793 PMCID: PMC4356699 DOI: 10.2147/ppa.s75876] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIM The aim of this study was to assess the rate of antiretroviral therapy (ART) adherence and to identify any determinants among adult patients. METHODS A cross-sectional study was conducted on 351 ART patients in the ART clinic of the University of Gondar referral hospital. Data were collected by a pretested interviewer-administered structured questionnaire from May to June 2014. Multivariate logistic regression was used to determine factors significantly associated with adherence. RESULTS Of 351 study subjects, women were more predominant than men (64.4% versus 35.6%). Three hundred and forty (96.9%) patients agreed and strongly agreed that the use of ART is essential in their life, and approximately 327 (93.2%) disclosed their sero-status to family. Seventy-nine (22.5%) participants were active substance users. The level of adherence was 284 (80.9%). Three hundred forty-one (97.2%) respondents had good or fair adherence. Among the reasons for missing doses were forgetfulness (29 [43.3%]), missing appointments (14 [20.9%]), running out of medicine (9 [13.4%]), depression, anger, or hopelessness (4 [6.0%]), side effects of the medicine used (2 [3.0%]), and nonbelief in the ART (2 [3.0%]). The variables found significantly associated with non-adherence were age (P-value 0.017), employment (P-value 0.02), HIV disclosure (P-value 0.04), and comfortability to take ART in the presence of others (P-value 0.02). CONCLUSION From this study, it was determined that forgetfulness (43.3%) was the most common reason for missing doses. Also, employment and acceptance in using ART in the presence of others are significant issues observed for non-adherence. Hence, the ART counselor needs to place more emphasis on the provision and use of memory aids.
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Affiliation(s)
- Bayew Tsega
- Department of Clinical Pharmacy, University of Gondar, Gondar, Ethiopia
- Correspondence: Bayew Tsega, Department of Clinical Pharmacy, School of Pharmacy – College of Medicine and Health Sciences, PO Box 196, University of Gondar, Kebele 16, Gondar, Ethiopia, Email
| | | | - Zewdneh Shewamene
- Department of Pharmacology, School of Pharmacy – College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mental, Neurological, and Substance Use Disorders in People Living With HIV/AIDS in Low- and Middle-Income Countries. J Acquir Immune Defic Syndr 2014; 67 Suppl 1:S54-67. [DOI: 10.1097/qai.0000000000000258] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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: 166] [Impact Index Per Article: 16.6] [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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Marrazzo JM, del Rio C, Holtgrave DR, Cohen MS, Kalichman SC, Mayer KH, Montaner JSG, Wheeler DP, Grant RM, Grinsztejn B, Kumarasamy N, Shoptaw S, Walensky RP, Dabis F, Sugarman J, Benson CA. HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA 2014; 312:390-409. [PMID: 25038358 PMCID: PMC6309682 DOI: 10.1001/jama.2014.7999] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Emerging data warrant the integration of biomedical and behavioral recommendations for human immunodeficiency virus (HIV) prevention in clinical care settings. OBJECTIVE To provide current recommendations for the prevention of HIV infection in adults and adolescents for integration in clinical care settings. DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS Data published or presented as abstracts at scientific conferences (past 17 years) were systematically searched and reviewed by the International Antiviral (formerly AIDS) Society-USA HIV Prevention Recommendations Panel. Panel members supplied additional relevant publications, reviewed available data, and formed recommendations by full-panel consensus. RESULTS Testing for HIV is recommended at least once for all adults and adolescents, with repeated testing for those at increased risk of acquiring HIV. Clinicians should be alert to the possibility of acute HIV infection and promptly pursue diagnostic testing if suspected. At diagnosis of HIV, all individuals should be linked to care for timely initiation of antiretroviral therapy (ART). Support for adherence and retention in care, individualized risk assessment and counseling, assistance with partner notification, and periodic screening for common sexually transmitted infections (STIs) is recommended for HIV-infected individuals as part of care. In HIV-uninfected patients, those persons at high risk of HIV infection should be prioritized for delivery of interventions such as preexposure prophylaxis and individualized counseling on risk reduction. Daily emtricitabine/tenofovir disoproxil fumarate is recommended as preexposure prophylaxis for persons at high risk for HIV based on background incidence or recent diagnosis of incident STIs, use of injection drugs or shared needles, or recent use of nonoccupational postexposure prophylaxis; ongoing use of preexposure prophylaxis should be guided by regular risk assessment. For persons who inject drugs, harm reduction services should be provided (needle and syringe exchange programs, supervised injection, and available medically assisted therapies, including opioid agonists and antagonists); low-threshold detoxification and drug cessation programs should be made available. Postexposure prophylaxis is recommended for all persons who have sustained a mucosal or parenteral exposure to HIV from a known infected source and should be initiated as soon as possible. CONCLUSIONS AND RELEVANCE Data support the integration of biomedical and behavioral approaches for prevention of HIV infection in clinical care settings. A concerted effort to implement combination strategies for HIV prevention is needed to realize the goal of an AIDS-free generation.
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Affiliation(s)
| | | | - David R Holtgrave
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | - Beatriz Grinsztejn
- Evandro Chagas Clinical Research Institute (IPEC)-FIOCRUZ, Rio de Janeiro, Brazil
| | - N Kumarasamy
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
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Lorío M, Colasanti J, Moreira S, Gutierrez G, Quant C. Adverse Drug Reactions to Antiretroviral Therapy in HIV-Infected Patients at the Largest Public Hospital in Nicaragua. ACTA ACUST UNITED AC 2014; 13:466-70. [DOI: 10.1177/2325957414535978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Adverse drug reactions (ADRs) to antiretroviral therapy (ART) are an important cause of hospitalization, treatment discontinuation, and regimen changes in both developed and developing countries. This study is the first to examine and understand ADRs in HIV-infected patients in Nicaragua. Methods: A retrospective descriptive study was conducted from May 2010 to March 2011, in a cohort of HIV-infected patients receiving ART at the largest public hospital in Managua, Nicaragua. Patients were identified based on ADRs reporting on a standardized antiretroviral pharmacotherapy form. Subsequently, chart reviews of these patients were performed in order to document the specific ADRs. Results: Six hundred ninety-two patients on ART were included. The incidence of ADRs was 6.4% (95% confidence interval [CI] 4.5-8.2). Females demonstrated a higher incidence, that is, 10.2% (95% CI 5.3-15.1, P = .020). Patients treated with combinations of zidovudine (ZDV)/lamivudine (3TC) and emtricitabine (FTC)/tenofovir (TDF) had fewer ADRs ( P < .01) than those using other combinations. Five patients were hospitalized or had a prolonged hospitalization secondary to ADRs, with no mortality attributed to ADR. The most common manifestations of ADRs were central nervous system (20 of 44), gastrointestinal (12 of 44), and dermatologic (8 of 44) reactions. Adverse drug reactions were classified as “likely ADRs” (25 of 44) and “possible ADRs” (19 of 44). No ADRs were preventable. Conclusion: Adverse drug reactions most frequently affected the central nervous system. No ADR was life threatening. The frequency of ADRs in this Nicaraguan patient population was less than that reported from other studies in resource-limited settings.
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Affiliation(s)
- Marco Lorío
- Internal Medicine, University of Miami, Miami, FL, USA
- Division of Infectious Diseases, Hospital Dr. Roberto Calderón Gutiérrez, Managua, Nicaragua
| | | | - Sumaya Moreira
- Division of Infectious Diseases, Hospital Dr. Roberto Calderón Gutiérrez, Managua, Nicaragua
| | | | - Carlos Quant
- Division of Infectious Diseases, Hospital Dr. Roberto Calderón Gutiérrez, Managua, Nicaragua
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Lana LGC, Junqueira DRG, Perini E, Menezes de Pádua C. Lipodystrophy among patients with HIV infection on antiretroviral therapy: a systematic review protocol. BMJ Open 2014; 4:e004088. [PMID: 24625638 PMCID: PMC3963089 DOI: 10.1136/bmjopen-2013-004088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Lipodystrophy is a frequent and disfiguring adverse effect of antiretroviral therapy (ART) in patients with HIV. It affects the quality of life of the patient and adherence to treatment, and generates new needs for comprehensive healthcare services. The aim of this study will be to conduct a systematic review of the literature from observational studies and describe lipodystrophy among patients with HIV infection during current or previous use of ART. METHODS AND ANALYSIS A systematic review of observational studies published in MEDLINE, CINAHL, LILACS, EMBASE and International Pharmaceutical Abstracts will be carried out. Citations of included studies will be checked to identify additional studies not identified in the electronic searches. It will include any observational study that considered lipodystrophy as the primary or secondary outcome and that had enrolled adolescent and adult patients with HIV infection who were on current or previous ART for at least 6 months. Data extraction and analysis will be performed independently by two reviewers. The extracted data will be discussed, decisions documented and, where necessary, the authors of the studies will be contacted for clarification. Measures of frequency, prevalence and incidence of lipodystrophy will be stratified according to definition, method of diagnosis and risk factors of the outcome. ETHICS AND DISSEMINATION Ethics is not required given this is a protocol for a systematic review. The findings of this study will be widely disseminated through peer-reviewed publications and conference presentations. Updates of the review will be conducted to inform and guide healthcare practice. PROTOCOL REGISTRATION PROSPERO-42013005450.
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Affiliation(s)
- Lorena Gomes Cunha Lana
- Departamento de Farmácia Social, Faculdade de Farmácia, Centro de Estudos do Medicamento (Cemed), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Daniela Rezende Garcia Junqueira
- Departamento de Farmácia Social, Faculdade de Farmácia, Centro de Estudos do Medicamento (Cemed), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
- Programa de Pós-graduação em Ciências Farmacêuticas, Universidade de Sorocaba-Uniso, Sorocaba, São Paulo, Brazil
| | - Edson Perini
- Departamento de Farmácia Social, Faculdade de Farmácia, Centro de Estudos do Medicamento (Cemed), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Cristiane Menezes de Pádua
- Departamento de Farmácia Social, Faculdade de Farmácia, Centro de Estudos do Medicamento (Cemed), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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Damasceno LS, Ramos AN, Alencar CH, Gonçalves MVF, de Mesquita JRL, Soares ATD, Coutinho AGN, Dantas CC, Leitão TDMJS. Disseminated histoplasmosis in HIV-infected patients: determinants of relapse and mortality in a north-eastern area of Brazil. Mycoses 2014; 57:406-13. [PMID: 24612078 DOI: 10.1111/myc.12175] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 12/07/2013] [Accepted: 01/25/2014] [Indexed: 11/30/2022]
Abstract
Many relapses and deaths resulting from disseminated histoplasmosis (DH) in acquired immunodeficiency syndrome (AIDS) patients have been observed in an endemic area in north-eastern Brazil. The objective of this study was to evaluate the risk factors associated with the clinical outcomes of DH/AIDS coinfection in patients from the state of Ceará, Brazil. A retrospective cohort of AIDS patients, after their hospital discharge due to first DH episode in the period 2002-2008, was followed until December 31, 2010, to investigate the factors associated with relapse and mortality. A total of 145 patients were evaluated in the study. Thirty patients (23.3%) relapsed and the overall mortality was 30.2%. The following variables were significantly (P < 0.05) associated with relapse and overall mortality (univariate analysis): non-adherence to highly active antiretroviral therapy (HAART), irregular use of an antifungal, non-recovery of the CD4+ count and having AIDS before DH; histoplasmosis relapse was also significantly associated with mortality. In the multivariate analysis, non-adherence to HAART was the independent risk factor that was associated with both relapse (Adj OR = 6.28) and overall mortality (Adj OR = 8.03); efavirenz usage was discovered to be significant only for the overall mortality rate (Adj OR = 4.50). Adherence to HAART was the most important variable that influenced the outcomes in this specific population.
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Affiliation(s)
- Lisandra Serra Damasceno
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Hospital São José of Infectious Disease, Fortaleza, CE, Brazil
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Zubaran C, Michelim L, Foresti K, Medeiros G, May W, Madi JM. Retention in medical care and antiretroviral treatment according to skin color in southern Brazil. J Int Assoc Provid AIDS Care 2013; 13:170-7. [PMID: 23697777 DOI: 10.1177/2325957413488178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to compare the retention in medical care and antiretroviral (ARV) treatment of individuals living with HIV and AIDS to antiretroviral therapy in southern Brazil according to their "race" or skin color. This study is part of a 225-day prospective trial, comprising 7 interviews, in which an intervention designed to improve adherence to treatment was tested. A convenience sample of 73 individuals living with HIV and/or AIDS enrolled in this follow-up procedure. The mean length of continuance in treatment was 161.5 (standard deviation [SD] = 18.6; 95% confidence interval [CI] = 125-198) and 138.4 (SD = 14.1; 95% C.I. = 111-166) days in the "nonwhite" and "white" categories, respectively. There was no significant difference between the 2 categories, χ(2)(1, n = 72) = 0.76, P = .38, which include similar levels of retention in medical care and treatment with ARV medications between groups of individuals categorized as white and nonwhite in this sample.
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Affiliation(s)
- Carlos Zubaran
- School of Medicine, University of Western Sydney, Australia
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de Fatima Bonolo P, Ceccato MDGB, Rocha GM, de Assis Acúrcio F, Campos LN, Guimarães MDC. Gender differences in non-adherence among Brazilian patients initiating antiretroviral therapy. Clinics (Sao Paulo) 2013; 68:612-20. [PMID: 23778401 PMCID: PMC3654293 DOI: 10.6061/clinics/2013(05)06] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 01/03/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We conducted a study to identify gender differences in factors associated with the first episode of non-adherence in the 12 months following the first antiretroviral prescription. METHODS A concurrent prospective study of patients initiating antiretroviral therapy in Brazil was conducted from 2001-2002. The self-reported measurement of adherence was defined as an intake of less than 95% of the prescribed number of doses. Only the first occurrence of non-adherence was considered in this analysis. All analyses were stratified by gender. A Cox proportional hazard model was used to estimate the risk of non-adherence, and the time to non-adherence was estimated using the Kaplan-Meier method. RESULTS The cumulative incidence of non-adherence was 34.6% (29.7% and 43.9% among men and women, respectively; p=0.010). Marital status (being married or in stable union; p=0.022), alcohol use in the month prior to the baseline interview (p=0.046), and current tobacco use (p=0.005) increased the risk of non-adherence among female participants only, whereas a self-reported difficulty with the antiretroviral treatment was associated with non-adherence in men only. For both men and women, we found that a longer time between the HIV test and first antiretroviral therapy prescription (p=0.028) also presented an increased risk of non-adherence. CONCLUSIONS In this cohort study, the incidence of non-adherence was 1.5 times greater among women compared to men. Our results reinforce the need to develop interventions that account for gender differences in public referral centers. Additionally, we emphasize that, to achieve and maintain appropriate adherence levels, it is important to understand the barriers to seeking and utilizing health care services.
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Crozatti MTL, França-Junior I, Rodrigues R, Carneiro Ferrão MDS, Brigido LFM, Della Negra M, Campéas AE, Castilho Raymundo ME, Marques SR, Waldman EA. Antiretroviral treatment adherence in childhood and adolescence: multidisciplinary team as an associated factor in Brazil. AIDS Care 2013; 25:1462-9. [PMID: 23452050 DOI: 10.1080/09540121.2013.774312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Our aim was to analyze factors associated with non-adherence to antiretroviral (ARV) treatment among children and adolescents. A cross-sectional study was carried out involving non-institutionalized children and adolescents between 2 and 20 years of age, addressing non-adherence to ARV treatment, which was defined as taking ≤89% of the medications on the day of the interview and the three previous days. The investigation into the association between non-compliance and the variables of interest was performed using unconditional logistic regression. The independent factors associated with non-adherence were forgetfulness (OR = 3.22; 95%CI = 1.75-5.92), difficulties coping with treatment (OR = 2.65; 95%CI = 1.03-6.79), and living with grandparents (OR = 2.28; 95%CI = 1.08-4.83), whereas a protective effect was found with participation in multidisciplinary activities (OR = 0.49; 95%CI = 0.25-0.96), i.e., this factor indicates that the exposure to the variable is beneficial, promoting adherence. We concluded that forgetting to take the medications and reporting having difficulty coping with ARV treatment are potentially modifiable factors through educational and programmatic actions. Residing with one's grandparents may strongly impact adherence to ARV treatment, indicating the need for the systematic support of these family members. Participation in multidisciplinary activities should be stimulated at health-care services.
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Zubaran C, Michelim L, Medeiros G, May W, Foresti K, Madi JM. A randomized controlled trial of a protocol of interviews designed to improve adherence to antiretroviral medications in southern Brazil. Int J STD AIDS 2012; 23:429-34. [DOI: 10.1258/ijsa.2011.011268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate the efficacy of the Portuguese version of the Medication Adherence Training Instrument (MATI) for improving adherence to antiretroviral therapy (ART) in southern Brazil. Two different follow-up modalities were compared in this 225 days randomized controlled study: one based on the MATI protocol and a conventional (non-MATI) clinical follow-up. There were no differences between the groups with the exception of socioeconomic class ( P < 0.005). The mean length of continuance in treatment was 111.4 (SD = 13.9) and 137.6 (SD = 17.3) days in the MATI and non-MATI groups, respectively. A Mantel–Cox log-rank test revealed no significant difference between the two interventions ( P = 0.34). Despite the sample size limitation, the results from this study indicate that the Portuguese version of the MATI was not more efficacious than the regular follow-up intervention for improving adherence of outpatients to ART.
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Affiliation(s)
- C Zubaran
- School of Medicine, University of Western Sydney
- Department of Psychiatry, Western Sydney Local Health District, Sydney, Australia
- School of Medicine, University of Caxias do Sul, Caxias do Sul, Brazil
| | - L Michelim
- School of Medicine, University of Caxias do Sul, Caxias do Sul, Brazil
| | - G Medeiros
- School of Medicine, University of Caxias do Sul, Caxias do Sul, Brazil
| | - W May
- School of Medicine, University of Caxias do Sul, Caxias do Sul, Brazil
| | - K Foresti
- Department of Psychiatry, Western Sydney Local Health District, Sydney, Australia
- School of Medicine, University of Caxias do Sul, Caxias do Sul, Brazil
| | - J M Madi
- School of Medicine, University of Caxias do Sul, Caxias do Sul, Brazil
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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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Morillo Verdugo R, Jiménez Galán R, Almeida González C. [Multidisciplinary perspective on support for antiretroviral therapy adherence in Andalusia. Andhalusida study]. FARMACIA HOSPITALARIA 2012; 36:410-23. [PMID: 22440519 DOI: 10.1016/j.farma.2011.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 08/02/2011] [Accepted: 08/25/2011] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To analyse physicians', pharmacists' and nurses' perspectives on the importance of different antiretroviral treatment adherence support activities and identify the main obstacles to meeting established recommendations which health professionals encounter. METHOD Cross-sectional observational and analytical study. Three questionnaires were designed based on 2008 GESIDA/SEFH/PNS recommendations for improving treatment adherence: "ideal measures" (IM), "real measures" (RM) and "adherence support problems" (ASP). Cronbach's Alpha index was determined to analyse questionnaire reliability and correlation coefficients between the MI and MR scales. We applied the Chi-square test or Monte Carlo method to analyse the correlation between health providers and items on the three questionnaires. RESULTS Participants consisted of 58 health professionals. The response rate was 76%. The Cronbach Alpha indices for the IM, RM and ASP questionnaires were 0.852, 0.933 and 0.818 respectively. The resulting intraclass correlation coefficient was 0.280. Significant differences were found for multiple comparisons of IM and RM questionnaires among physicians and pharmacists. The analysis of relationships between providers also found significant differences for one of the answers on the IM questionnaire, three on the RM and five on the ASP. CONCLUSIONS We observed that several health professionals have different perspectives on measures of support for treatment adherence, with differences arising mainly due to lack of time and training.
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Affiliation(s)
- R Morillo Verdugo
- Servicio de Farmacia, Hospital Universitario de Valme, Sevilla, España.
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Alcohol Consumption, Progression of Disease and Other Comorbidities, and Responses to Antiretroviral Medication in People Living with HIV. AIDS Res Treat 2012; 2012:751827. [PMID: 22496971 PMCID: PMC3310201 DOI: 10.1155/2012/751827] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 12/13/2011] [Accepted: 01/02/2012] [Indexed: 12/13/2022] Open
Abstract
The present paper describes the possible connection between alcohol consumption and adherence to medicine used to treat human deficiency viral (HIV) infection. Highly active antiretroviral therapy (HAART) has a positive influence on longevity in patients with HIV, substantially reducing morbidity and mortality, including resource-poor settings such as South Africa. However, in a systematic comparison of HAART outcomes between low-income and high-income countries in the treatment of HIV-patients, mortality was higher in resource-poor settings. Specifically, in South Africa, patients often suffer from concomitant tuberculosis and other infections that may contribute to these results. Alcohol influences the use of medicine for opportunistic infections (e.g., pneumonia, tuberculosis), or coinfections HIV-hepatitis viruses-B (HBV) and C (HCV), cytomegalovirus, or herpes simplex virus. Furthermore, alcohol use may negatively impact on medication adherence contributing to HIV progression. The materials used provide a data-supported approach. They are based on analysis of published (2006–2011) world literature and the experience of the authors in the specified topic. Intended for use by health care professionals, these recommendations suggest approaches to the therapeutic and preventive aspects of care. Our intention was to fully characterize the quality of evidence supporting recommendations, which are reflecting benefit versus risk, and assessing strength or certainty.
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Women and vulnerability to HAART non-adherence: a literature review of treatment adherence by gender from 2000 to 2011. Curr HIV/AIDS Rep 2012; 8:277-87. [PMID: 21989672 DOI: 10.1007/s11904-011-0098-0] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A literature review of original research articles on adherence to antiretroviral therapy (ART) in developed countries, covering January 2000 to June 2011, was conducted to determine if gender differences exist in the prevalence of nonadherence to ART. Of the 1,255 articles reviewed, only 189 included data on the proportion of the study population that was adherent and only 57 (30.2%) of these reported proportional adherence values by gender. While comparing articles was challenging because of varied reporting strategies, women generally exhibit poorer adherence than men. Thirty of the 44 articles (68.2%) that reported comparative data on adherence by gender found women to be less adherent than men. Ten articles (17.5%) reported significant differences in proportional adherence by gender, nine of which showed women to be less adherent than men. These findings suggest that in multiple studies from developed countries, female gender often predicts lower adherence. The unique circumstances of HIV-positive women require specialized care to increase adherence to ART.
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Ribeiro FA, Tupinambás U, Fonseca MO, Greco DB. Durability of the first combined antiretroviral regimen in patients with AIDS at a reference center in Belo Horizonte, Brazil, from 1996 to 2005. Braz J Infect Dis 2012. [DOI: 10.1016/s1413-8670(12)70270-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Souza ES, dos Santos NR, Valentini SZ, da Silva GA, Figueiroa JN, Falbo AR. Predictors of long-term anti-retroviral therapy effectiveness among Brazilian HIV-1-infected children in a hybrid scenario: what really matters? J Trop Pediatr 2011; 57:197-203. [PMID: 20823088 DOI: 10.1093/tropej/fmq082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The study objective was to evaluate the effectiveness and durability of highly active anti-retroviral therapy (HAART) in perinatally HIV-1-infected children and adolescents and its predictors. A historical cohort study was done at IMIP's Hospital in Recife, Brazil. The study included 195 subjects, 102 (52.3%) had successful response to HAART with a mean time of any HAART use of 4.9 [standard deviation (SD) 2.5; min. 0.7, max. 9.9] years. The time to failure of first HAART was negatively associated with male sex [relative hazard (RH) = 0.5, p = 0.021) and living out of metropolitan area (RH = 0.4, p = 0.009), and associated with Centres for Diseases Control and Prevention (CDC) immunological Stage 1 (RH = 2.9, p = 0.003) and patients who were adherent (RH = 2.2, p = 0.003). HAART success rate and mean time durability was similar to developed country data. However, the main predictors of success were: female sex, living in a metropolitan area, CDC1 immunological category and adherence.
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Rachlis BS, Mills EJ, Cole DC. Livelihood security and adherence to antiretroviral therapy in low and middle income settings: a systematic review. PLoS One 2011; 6:e18948. [PMID: 21589911 PMCID: PMC3093377 DOI: 10.1371/journal.pone.0018948] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 03/18/2011] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION We sought to examine the association between livelihood security and adherence to antiretroviral therapy (ARVs) in low- and middle-income countries (LIMC). METHODS Performing a systematic review, we searched, independently and in duplicate, 7 electronic databases and 2 conference websites for quantitative surveys that examined the association between indicators of livelihood security and adherence to ARVs in LIMC between 2000-2010. Criteria for relevance were applied to complete papers (quantitative study with estimates of associations) and quality assessment was conducted on those deemed relevant. We performed three regressions to measure the association between each type of livelihood and adherence. RESULTS Twenty original studies and 6 conference abstracts were included, the majority from Africa (n = 16). Seventeen studies and 3 conference abstracts were cross-sectional and 3 studies and 3 abstracts were prospective clinical cohort studies, with considerable variation in quality for studies of each design type. Among the diverse populations represented, we observed considerable variation in associations between measurements of livelihood indicators and increasingly accepted adherence measures, irrespective of study design or quality. A financial capital indicator, financial constraints/payment for ARV medication, was more commonly associated with non-adherence (3/5 studies). A human capital indicator, educational level, was most commonly associated with adherence (11/20 studies). DISCUSSION Additional better quality research examining livelihood security is required to inform provision of optimal supports for adherence and mitigation of the impacts of HIV/AIDS.
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Affiliation(s)
- Beth S Rachlis
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Rocha GM, Machado CJ, Acurcio FDA, Guimarães MDC. Monitoring adherence to antiretroviral treatment in Brazil: an urgent challenge. CAD SAUDE PUBLICA 2011; 27 Suppl 1:S67-78. [DOI: 10.1590/s0102-311x2011001300008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 04/05/2010] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to describe the effect of non-adherence on the main laboratory outcomes, TCD4+ lymphocyte count and viral load, routinely used to monitor patients initiating treatment according to three different approaches to measure adherence to antiretroviral therapy. Among 288 participants, 22.9%, 31.9% and 74.3% were considered non-adherent, according to medical charts, self-report and pharmacy records, respectively. Depending on the adherence measures used, the average gain in TCD4+ lymphocyte count ranged from 142.4 to 195.4 cells/mm3 among adherent patients, and from 58.5 to 99.8 lymphocytes TCD4+/mm3 among those non-adherent. The average reduction on viral load ranged from 4.25 to 4.62 log copies/mL among the adherent patients, and from 1.99 to 4.07 log among those non-adherent. Monitoring antiretroviral adherence should be considered a priority in these public AIDS referral centers in order to identify patients at high risk of developing virologic failure. Early interventions are necessary in order to maintain the initial therapeutic regimens for longer periods.
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Predictors of adherence to antiretroviral therapy among people living with HIV/AIDS in resource-limited setting of southwest ethiopia. AIDS Res Ther 2010; 7:39. [PMID: 21034506 PMCID: PMC2988692 DOI: 10.1186/1742-6405-7-39] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Accepted: 10/30/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Good adherence to antiretroviral therapy is necessary to achieve the best virological response, lower the risk that drug resistance will develop, and reduce morbidity and mortality. Little is known about the rate and predictors of adherence in Ethiopia. Therefore this study determines the magnitude and predictors of adherence to antiretroviral therapy among people living with HIV/AIDS in Southwest Ethiopia. METHODS A cross sectional study was carried out from January 1, 2009 to March 3, 2009 among 319 adult PLWHA (≥ 18 years) attending ART clinic at Jimma university Specialized Hospital (JUSH). Multiple Logistic regression models were constructed with adherence and independent variables to identify the predictors. RESULTS About 303(95%) of the study subjects were adherent based on self report of missed doses (dose adherence) in a one-week recall before the actual interview. The rate of self reported adherence in the study based on the combined indicator of the dose, time and food adherence measurement was 72.4%. Patients who got family support were 2 times [2.12(1.25-3.59)] more likely to adhere than those who didn't get family support as an independent predictor of overall adherence (dose, time and food). The reasons given for missing drugs were 9(27.3%) running out of medication/drug, 7(21.2%) being away from home and 7(21.2%) being busy with other things. CONCLUSION The adherence rate found in this study is similar to other resource limited setting and higher than the developed country. This study highlights emphasis should be given for income generating activities and social supports that helps to remember the patients for medication taking and management of opportunistic infections during the course of treatment.
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Melo APS, César CC, Acurcio FDA, Campos LN, Ceccato MDGB, Wainberg ML, McKinnon K, Guimarães MDC. Individual and treatment setting predictors of HIV/AIDS knowledge among psychiatric patients and their implications in a national multisite study in Brazil. Community Ment Health J 2010; 46:505-16. [PMID: 20352331 DOI: 10.1007/s10597-010-9303-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 03/10/2010] [Indexed: 11/27/2022]
Abstract
The objective of this study is to measure HIV/AIDS knowledge among patients with mental illness in Brazil and to examine individual and treatment setting predictors of knowledge. We conducted a cross-sectional national multicenter study among 2,475 patients in 26 randomly selected mental health institutions throughout Brazil. We used Item Response Theory to standardize knowledge scores and multilevel multiple linear regression to determine the effect of individual and treatment setting characteristics on standardized knowledge score. Schizophrenia was the main diagnosis (48%) of participants. Mean knowledge score was 6.78 (range 1-10). Treatment setting characteristics were not associated with knowledge scores. Higher HIV/AIDS knowledge scores were significantly associated with a history of sexually transmitted disease (STD), previous HIV testing and consistent condom use; lower HIV/AIDS knowledge scores were significantly associated with specific sociodemographic, psychiatric, and HIV risk-perception factors. Psychiatric patients in Brazil lag behind the general population with knowledge scores comparable to those of nearly a decade ago. The mental health system in Brazil and elsewhere must consider strategies beyond dispensing information, for preventing HIV/AIDS transmission in the psychiatric population.
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Affiliation(s)
- Ana Paula Souto Melo
- Research Group in Epidemiology and Health Services Evaluation (GPEAS/CNPq), Department of Preventive and Social Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
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Alakija Kazeem Salami, Fadeyi A, Ogunmodede JA, Desalu O. Factors influencing adherence to antiretroviral medication in Ilorin, Nigeria. ACTA ACUST UNITED AC 2010; 9:191-5. [PMID: 20530474 DOI: 10.1177/1545109710368722] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Good adherence to highly active antiretroviral therapy (HAART) is required for viral suppression and prevention of drug resistance. Patients' adherence to HAART has not been determined since the commencement of HAART at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria, over 5 years ago. OBJECTIVES To determine the adherence level of people living with HIV/AIDS (PLWHA) to HAART and identify associated factors. METHODOLOGY A semistructured questionnaire was administered to PLWHA, who were accessing treatment. Sociodemographic, lifestyle, HIV medical, and drug history were obtained from them. Adherence was self-reported. Good adherence was taking of 95% of the prescribed doses of HAART over the preceding 30 days before consultation. RESULTS Study participants were 253; majority, 58.5%, were females. About 70.8% of them had good adherence. Older age and male sex correlated better with adherence. CONCLUSION People living with HIV/AIDS were quite adherent to HAART. Male sex and older age were positive predictors of adherence. Adherence among the young age and females needs strengthening.
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Campos LN, Guimarães MDC, Remien RH. Anxiety and depression symptoms as risk factors for non-adherence to antiretroviral therapy in Brazil. AIDS Behav 2010; 14:289-99. [PMID: 18648925 DOI: 10.1007/s10461-008-9435-8] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 07/11/2008] [Indexed: 10/21/2022]
Abstract
Depression and anxiety are common among HIV-infected people and rank among the strongest predictors of non-adherence to antiretroviral therapy (ART). This longitudinal study aimed to assess whether symptoms of anxiety and depression are predictors of non-adherence among patients initiating ART at two public referral centers (n = 293) in Belo Horizonte, Brazil. Prevalence of severe anxiety and depression symptoms before starting ART was 12.6% and 5.8%, respectively. Severe anxiety was a predictor of non-adherence to ART during follow-up period (RH = 1.87; 95% CI = 1.14-3.06) adjusted for low education, unemployment, alcohol use in the last month and symptoms of AIDS; while a history of injection drug use had borderline statistical significance with non-adherence. These findings suggest that using a brief screening procedure to assess anxiety and depression symptoms before initiating ART help identify individuals for interventions to improve adherence and quality of life.
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Fernandes JRM, Acurcio FDA, Campos LN, Guimarães MDC. [Initiation of antiretroviral therapy in HIV-infected patients with severe immunodeficiency in Belo Horizonte, Minas Gerais State, Brazil]. CAD SAUDE PUBLICA 2010; 25:1369-80. [PMID: 19503967 DOI: 10.1590/s0102-311x2009000600019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 01/28/2009] [Indexed: 11/22/2022] Open
Abstract
The main objective was to assess the proportion of delayed initiation of antiretroviral therapy (ART) and associated factors. This was a cross-sectional study of 310 patients enrolled in two public health centers in Belo Horizonte, Minas Gerais State, Brazil. Delayed ART initiation was defined as starting treatment with a CD4 count lower than 200 cells/mm(3) or clinical symptoms of severe immunodepression at the time of first antiretroviral prescription. The majority of participants were males (63.9%), had no health insurance (76.1%), and started ART less than 120 days after the first medical visit (75.2%). The proportion of delayed ART initiation was 68.4%. Unemployment, referral by a health professional for HIV testing, fewer than two medical visits in the six months prior to ART initiation, and time between first medical visit and ART initiation less than 120 days were independently associated with the outcome. Our results suggest that every patient 13 to 64 years of age should be offered HIV testing, which could increase the rate of early HIV diagnosis, and thus patients that tested positive could benefit from timely follow-up and antiretroviral therapy.
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Abstract
BACKGROUND Alcohol use is frequently implicated as a factor in nonadherence to highly active antiretroviral therapy (HAART). There have not been efforts to systematically evaluate findings across studies. This meta-analysis provides a quantitative evaluation of the alcohol-adherence association by aggregating findings across studies and examining potential moderators. METHODS Literature searches identified 40 qualifying studies totaling over 25,000 participants. Studies were coded on several methodological variables. RESULTS In the combined analysis, alcohol drinkers were approximately 50%-60% as likely to be classified as adherent [odds ratio (OR) = 0.548, 95% confidence interval (CI): 0.490 to 0.612] compared with abstainers (or those who drank relatively less). Effect sizes for problem drinking, defined as meeting the National Institute on Alcohol Abuse and Alcoholism criteria for at-risk drinking or criteria for an alcohol use disorder, were greater (OR = 0.474, 95% CI = 0.408 to 0.550) than those reflecting any or global drinking (OR = 0.604, 95% CI = 0.531 to 0.687). Several variables moderated the alcohol-adherence association. CONCLUSIONS Results support a significant and reliable association of alcohol use and medication nonadherence. Methodological variables seem to moderate this association and could contribute to inconsistent findings across studies. Future research would benefit from efforts to characterize theoretical mechanisms and mediators and moderators of the alcohol-adherence association.
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Tessema B, Biadglegne F, Mulu A, Getachew A, Emmrich F, Sack U. Magnitude and determinants of nonadherence and nonreadiness to highly active antiretroviral therapy among people living with HIV/AIDS in Northwest Ethiopia: a cross-sectional study. AIDS Res Ther 2010; 7:2. [PMID: 20180959 PMCID: PMC2845546 DOI: 10.1186/1742-6405-7-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 01/14/2010] [Indexed: 11/28/2022] Open
Abstract
Background Adequate antiretroviral drug potency is essential for obtaining therapeutic benefit, however, the behavioral aspects of proper adherence and readiness to medication, often determine therapeutic outcome. Therefore, this study aimed to assess the level and determinants of nonadherence and nonreadiness to highly active antiretroviral therapy (HAART) among people living with HIV/AIDS (PLWHA) at Gondar University Teaching Hospital and Felege Hiwot Hospital in Northwest Ethiopia. Methods A cross-sectional study was conducted between July and September 2008 using structured interviewer-administered questionnaire. All consecutive adult outpatients who were receiving antiretroviral treatment for at least three months, seen at both hospitals during the study period and able to give informed consent were included in the study. Multivariate logistic regression was used to determine factors associated with nonadherence and nonreadiness. Results A total of 504 study subjects were included in this study. The prevalence rates of nonadherence and nonreadiness to HAART were 87 (17.3%) and 70 (13.9%) respectively. Multivariate logistic regression analysis revealed that medication adverse effects, nonreadiness to HAART, contact with psychiatric care service and having no goal had statistically significant association with nonadherence. Moreover, unwillingness to disclose HIV status was significantly associated with nonreadiness to HAART. Conclusions In this study the level of nonadherence and nonreadiness to HAART seems to be encouraging. Several factors associated with nonadherance and nonreadiness to HAART were identified. Efforts to minimize nonadherence and nonreadiness to HAART should be integrated in to regular clinical follow up of patients.
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