Adult Clinical and Immunologic Outcomes of the National Antiretroviral Treatment Program in Rwanda During 2004-2005

Lowrance, David; Ndamage, François; Kayirangwa, Eugenie; Ndagije, Felix; Lo, Wilson H.Y.; Hoover, Donald R.; Hanson, Jeff; Elul, Batya; Ayaba, Aliou; Ellerbrock, Tedd V.; Rukundo, Alphonse; Shumbusho, Fabienne; Nash, Denis; Mugabo, Jules; Assimwe, Anita

doi:10.1097/qai.0b013e3181b03316

Cited by 56 publications

(64 citation statements)

References 21 publications

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“…With an HIV prevalence of 3.0% [11], Rwanda has been scaling up access to HIV care since 2004, and the mature national programme has achieved more than 93% ART coverage [12] with high rates of retention [13] and medication adherence with viral suppression [14]. We therefore examined the proportion of persons enrolling in HIV care and initiating ART in the advanced stages of HIV infection among patients in Kigali, Rwanda, before and after the first expansion of national ART guidelines from a CD4 + threshold of 200 cells/µl to 350 cells/µl.…”

Section: Introductionmentioning

confidence: 99%

Trends in and correlates of CD4+ cell count at antiretroviral therapy initiation after changes in national ART guidelines in Rwanda

Mutimura¹,

Addison

Anastos

et al. 2015

Aids

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Background Initiation of antiretroviral therapy (ART) in the advanced stages of HIV infection remains a major challenge in sub-Saharan Africa. This study was conducted to better understand barriers and enablers to timely ART initiation in Rwanda where ART coverage is high and national ART eligibility guidelines first expanded in 2007–2008. Methods Using data on 6326 patients (≥15 years) at five Rwandan clinics, we assessed trends and correlates of CD4+ cell count at ART initiation and the proportion initiating ART with advanced HIV disease (CD4+ <200 cells/µl or WHO stage IV). Results Out of 6326 patients, 4486 enrolling in HIV care initiated ART with median CD4+ cell count of 211 cells/µl [interquartile range: 131–300]. Median CD4+ cell counts at ART initiation increased from 183 cells/µl in 2007 to 293 cells/µl in 2011–2012, and the proportion with advanced HIV disease decreased from 66.2 to 29.4%. Factors associated with a higher odds of advanced HIV disease at ART initiation were male sex [adjusted odds ratios (AOR) = 1.7; 95% confidence interval (CI): 1.3–2.1] and older age (AOR46–55+ vs. <25 = 2.3; 95% CI: 1.2–4.3). Among those initiating ART more than 1 year after enrollment in care, those who had a gap in care of 12 or more months prior to ART initiation had higher odds of advanced HIV disease (AOR = 5.2; 95% CI: 1.2–21.1). Conclusion Marked improvements in the median CD4+ cell count at ART initiation and proportion initiating ART with advanced HIV disease were observed following the expansion of ART eligibility criteria in Rwanda. However, sex disparities in late treatment initiation persisted through 2011–2012, and appeared to be driven by later diagnosis and/or delayed linkage to care among men.

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Section: Introductionmentioning

confidence: 99%

Trends in and correlates of CD4+ cell count at antiretroviral therapy initiation after changes in national ART guidelines in Rwanda

Mutimura¹,

Addison

Anastos

et al. 2015

Aids

Self Cite

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“…[1][2][3] But the earlier optimism generated by its efficacy has dissipated in the face of the enormous challenge of maintaining nearly perfect adherence, without which patients risk adverse outcomes. 4 A major review of studies on ART adherence estimate it to be 77% in sub-Saharan Africa and nonadherence in the adult population to be 33-88%, depending on the measure of adherence employed.…”

Section: Introductionmentioning

confidence: 99%

Self-efficacy, medication beliefs and adherence to antiretroviral therapy by patients attending a health facility in Pretoria

Adefolalu

Nkosi

Olorunju

et al. 2014

South African Family Practice

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Background: Self-efficacy and medication beliefs are known factors that influence adherence to treatment in chronic medical conditions. We carried out a cross-sectional study on human immunodeficiency virus (HIV)-infected patients with the aim of determining the predictive relationship between these two variables and adherence to antiretroviral therapy (ART) at a health facility in Pretoria. Method: Participants' medication beliefs were assessed using the Beliefs about Medicines Questionnaire. Self-efficacy was evaluated using the HIV Adherence Self-Efficacy Scale, and adherence to ART determined using the AIDS Clinical Trial Group questionnaire. Results:The mean age of the 232 participants was 40 years (standard deviation 15.6). Seventy per cent were females. Most had been on ART for over two years (87%), and 81.5% were adherent to at least 95% of the prescribed antiretroviral drugs. Nonadherence was highest in those on ART for more than three years (63%). The mean HIV Adherence Self-Efficacy score was 6.45 out of a possible 10. Beliefs held by the participants about the importance of (necessity) and concerns about ART in the management of HIV infection were generally positive. There was a mean score of 4.05 out of 5, indicating a strong belief in the use of ART. There was a strong association between adherence self-efficacy and ART adherence (p < 0.001) in the nonadherent participants. Regression analysis showed significance for adherence self-efficacy on ART nonadherence (p < 0.041), with adherence self-efficacy explaining 9.8% of the variance. Conclusion: Patients' adherence self-efficacy explained a significant portion of variation in the nonadherence to ART, which suggests that low adherence self-efficacy is influential in ART nonadherence. Interventions aimed at improving adherence to ART should address adherence self-efficacy.

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“…18 Nevertheless, the statistical analysis showed no differences in documented deaths between patients with baseline CD4 þ counts of more than and less than 50 cells/mL after initiating HAART, which was inconsistent with the results in a foreign study. 18 A reasonable explanation is the short-term followup and the limited numbers of cases in our study compared with the populations in studies conducted in Western countries. Also, the loss-to-follow-up rate was 2% (1 of 49) for those who had received ART but were not seen in the outpatient department for more than 1 year and had incomplete data for evaluation.…”

Section: Discussionmentioning

confidence: 56%

Clinical manifestations of treatment-naive patients with acquired immunodeficiency syndrome and responses to highly active antiretroviral therapy in the Taipei Veterans General Hospital: A 5-year prospective study

Hsu¹,

Yang²,

Chan³

et al. 2011

Journal of Microbiology, Immunology and Infection

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Adult Clinical and Immunologic Outcomes of the National Antiretroviral Treatment Program in Rwanda During 2004-2005

Abstract: Rwanda's national ART program achieved excellent 6- and 12-month retention and immunologic outcomes during the first 2 years of rapid scale-up. Routine supervision is required to improve compliance with clinical guidelines and data quality.

Cited by 56 publications

References 21 publications

Trends in and correlates of CD4+ cell count at antiretroviral therapy initiation after changes in national ART guidelines in Rwanda

Trends in and correlates of CD4+ cell count at antiretroviral therapy initiation after changes in national ART guidelines in Rwanda

Self-efficacy, medication beliefs and adherence to antiretroviral therapy by patients attending a health facility in Pretoria

Clinical manifestations of treatment-naive patients with acquired immunodeficiency syndrome and responses to highly active antiretroviral therapy in the Taipei Veterans General Hospital: A 5-year prospective study

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