Antiretroviral Concentrations in Small Hair Samples as a Feasible Marker of Adherence in Rural Kenya

Hickey, Matthew D.; Salmen, Charles R.; Tessler, Robert A.; Omollo, Dan; Bacchetti, Peter; Magerenge, Richard; Mattah, Brian; Salmen, Marcus; Zoughbie, Daniel E.; Fiorella, Kathryn J.; Geng, Elvin; Njoroge, Betty; Jin, Chengshi; Huang, Yong; Bukusi, Elizabeth A.; Cohen, Craig R.; Gandhi, Monica

doi:10.1097/qai.0000000000000154

Cited by 84 publications

(108 citation statements)

References 42 publications

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“…In our study, the acceptability of hair collection was high (100%), which is consistent with prior studies by our group in Africa showing high rates of feasibility and acceptability (>95%) in hair collection. 8,12 Hair collection for exposure monitoring may be particularly desirable in pediatric populations, since hair sampling avoids phlebotomy. 24 However, we have shown that early implementation of community information campaigns and field staff training are important to enhance hair collection rates.…”

Section: Discussionmentioning

confidence: 99%

“…6,12 Approximately 20 strands of hair (1-3 mg) are required to measure the concentration of most ARVs. 13,14 Hair samples were cut from underneath the top layer of hair from the occiput 8,9 and then subsequently placed in aluminum foil, stored at room temperature, and shipped to the University of California, San Francisco (UCSF) for analysis.…”

Section: Hair Collectionmentioning

confidence: 99%

“…Hair levels of ARVs reflect drug uptake from the systemic circulation over preceding weeks to months 4,5 and have been shown to be strong and independent predictors of long-term adherence and associated treatment outcomes in adults, [6][7][8][9][10] and have been compared to other adherence measures in African children. 11 No prior study has examined associations between hair ARV levels and virologic outcomes in children.…”

Section: Introductionmentioning

confidence: 99%

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Using Lopinavir Concentrations in Hair Samples to Assess Treatment Outcomes on Second-Line Regimens Among Asian Children

Prasitsuebsai

Kerr

Truong

et al. 2015

AIDS Research and Human Retroviruses

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We conducted a prospective monitoring study to determine whether antiretroviral (ARV) levels in hair of Asian children on second-line protease inhibitor-based ARV therapy (ART) are associated with virologic failure (VF), compared to plasma drug levels and self-reported adherence. HIV-infected Asian children on second-line ART regimens were enrolled into a longitudinal cohort. Traditional adherence measures, plasma, and hair samples were collected 24 weeks after study enrollment. Hair ARV levels were determined via liquid chromatography/ tandem mass spectrometry. Among 149 children on lopinavir/ritonavir-based regimens, 47% were female; the median [interquartile range (IQR)] age was 10.3 (7.9-13.3) years. The median CD4% was 26% (IQR 21.7-32.1%) and the median CD4 cell count 754 (IQR 596-1,013) cells/mm 3 . The median duration of lopinavirbased ART prior to week 24 of the study was 2.9 (IQR 1.6-4.2) years. Adherence was >95% in 91% (135/148) by visual analogue scale and 89% (129/145) by pill count. The median lopinavir hair concentrations were 5.43 (IQR 3.21-9.01) ng/mg in children with HIV RNA >1,000 copies/ml and 9.96 (IQR 6.51-12.31) ng/mg in children with HIV RNA <1,000 copies/ml ( p = 0.003). Plasma trough and lopinavir hair concentrations were not statistically significantly correlated (Pearson's correlation coefficient 0.20; p = 0.13). Increasing lopinavir hair concentrations in quartiles were strongly associated with virologic success (odds ratios ‡4.0, overall p = 0.02), while self-reported adherence, pill count, and plasma lopinavir levels were not. Based on this first report of hair ARV concentrations and virologic outcomes in children, ARV hair concentrations, representing longer-term adherence, may be useful to identify children at risk for VF.

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Section: Discussionmentioning

confidence: 99%

Section: Hair Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Using Lopinavir Concentrations in Hair Samples to Assess Treatment Outcomes on Second-Line Regimens Among Asian Children

Prasitsuebsai

Kerr

Truong

et al. 2015

AIDS Research and Human Retroviruses

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“…A recent study from rural Kenya showed that community information campaigns and field staff training early in protocol development was likely to enhance hair collection rates [14]. A qualitative study from South Africa on the acceptability of hair collection underscored this point [15].…”

Section: Discussionmentioning

confidence: 99%

“…Hair collection has been shown to be feasible and acceptable (>95%) among HIV-infected or at-risk individuals in Africa [3,14]. A recent study from rural Kenya showed that community information campaigns and field staff training early in protocol development was likely to enhance hair collection rates [14].…”

Section: Discussionmentioning

confidence: 99%

Strong Correlation Between Concentrations of Tenofovir (TFV) Emtricitabine (FTC) in Hair and TFV Diphosphate and FTC Triphosphate in Dried Blood Spots in the iPrEx Open Label Extension: Implications for Pre-exposure Prophylaxis Adherence Monitoring

Gandhi¹,

Glidden²,

Liu³

et al. 2015

J Infect Dis.

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Self-reported adherence to pre-exposure prophylaxis (PrEP) has limitations, raising interest in pharmacologic monitoring. Drug concentrations in hair and dried blood spots (DBS) are used to assess long-term-exposure; hair shipment/storage occurs at room temperature. The iPrEx Open Label Extension collected DBS routinely, with opt-in hair collection; concentrations were measured with liquid chromatography/tandem mass spectrometry. In 806 hair-DBS pairs, tenofovir (TFV) hair levels and TFV diphosphate (DP) in DBS were strongly correlated (Spearman coefficient r = 0.734; P < .001), as were hair TFV/DBS emtricitabine (FTC) triphosphate (TP) (r = 0.781; P < .001); hair FTC/DBS TFV-DP (r = 0.74; P < .001); hair FTC/DBS FTC-TP (r = 0.587; P < .001). Drug detectability was generally concordant by matrix. Hair TFV/FTC concentrations correlate strongly with DBS levels, which are predictive of PrEP outcomes.

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Measuring patient engagement with HIV care in sub‐Saharan Africa: a scoping study

et al. 2022

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Introduction:Engagement with HIV care is a multi-dimensional, dynamic process, critical to maintaining successful treatment outcomes. However, measures of engagement are not standardized nor comprehensive. This undermines our understanding of the scope of challenges with engagement and whether interventions have an impact, complicating patient and programmelevel decision-making. This study identified and characterized measures of engagement to support more consistent and comprehensive evaluation. Methods: We conducted a scoping study to systematically categorize measures the health system could use to evaluate engagement with HIV care for those on antiretroviral treatment. Key terms were used to search literature databases (Embase, PsychINFO, Ovid Global-Health, PubMed, Scopus, CINAHL, Cochrane and the World Health Organization Index Medicus), Google Scholar and stakeholder-identified manuscripts, ultimately including English evidence published from sub-Saharan Africa from 2014 to 2021. Measures were extracted, organized, then reviewed with key stakeholders. Results and discussion: We screened 14,885 titles/abstracts, included 118 full-texts and identified 110 measures of engagement, categorized into three engagement dimensions ("retention," "adherence" and "active self-management"), a combination category ("multi-dimensional engagement") and "treatment outcomes" category (e.g. viral load as an end-result reflecting that engagement occurred). Retention reflected status in care, continuity of attendance and visit timing. Adherence was assessed by a variety of measures categorized into primary (prescription not filled) and secondary measures (medication not taken as directed). Active self-management reflected involvement in care and self-management. Three overarching use cases were identified: research to make recommendations, routine monitoring for quality improvement and strategic decision-making and assessment of individual patients. Conclusions: Heterogeneity in conceptualizing engagement with HIV care is reflected by the broad range of measures identified and the lack of consensus on "gold-standard" indicators. This review organized metrics into five categories based on the dimensions of engagement; further work could identify a standardized, minimum set of measures useful for comprehensive evaluation of engagement for different use cases. In the interim, measurement of engagement could be advanced through the assessment of multiple categories for a more thorough evaluation, conducting sensitivity analyses with commonly used measures for more comparable outputs and using longitudinal measures to evaluate engagement patterns. This could improve research, programme evaluation and nuanced assessment of individual patient engagement in HIV care.

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Antiretroviral Concentrations in Small Hair Samples as a Feasible Marker of Adherence in Rural Kenya

Cited by 84 publications

References 42 publications

Using Lopinavir Concentrations in Hair Samples to Assess Treatment Outcomes on Second-Line Regimens Among Asian Children

Using Lopinavir Concentrations in Hair Samples to Assess Treatment Outcomes on Second-Line Regimens Among Asian Children

Strong Correlation Between Concentrations of Tenofovir (TFV) Emtricitabine (FTC) in Hair and TFV Diphosphate and FTC Triphosphate in Dried Blood Spots in the iPrEx Open Label Extension: Implications for Pre-exposure Prophylaxis Adherence Monitoring

Measuring patient engagement with HIV care in sub‐Saharan Africa: a scoping study

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