Assessment of a pilot antiretroviral drug therapy programme in Uganda: patients' response, survival, and drug resistance

Weidle, Paul J.; Malamba, Samuel; Mwebaze, Raymond; Sozi, Catherine; Rukundo, Gideon; Downing, Robert; Hanson, Debra L.; Ochola, Dorothy; Mugyenyi, Peter; Mermin, Jonathan; Samb, Badara; Lackritz, Eve

doi:10.1016/s0140-6736(02)09330-3

Cited by 257 publications

(190 citation statements)

References 16 publications

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“…These high levels of adherence confirm findings in other resource-limited settings (Byakika-Tusiime et al 2005;Fong et al 2003;Landman et al 2003;Laniece et al 2003;Laurent et al 2004;Laurent et al 2005a, b;Nachega et al 2004;Orrell et al 2003;Oyugi et al 2004;Remien et al 2003;Weidle et al 2002;Weiser et al 2003). Our findings contrast with those of Merenstein et al (2008), who found an inverse relationship between adherence and the number of children in the family.…”

Section: Discussionsupporting

confidence: 82%

“…While most studies have shown high levels of adherence to ART in resource-constrained settings Bisson et al 2008;Byakika-Tusiime et al 2005;Diabate et al 2007;Etard et al 2007;Fong et al 2003;Landman et al 2003;Laniece et al 2003;Laurent et al 2004;Laurent et al 2005a, b;Mills et al 2006b;Nachega et al 2004;Orrell et al 2003;Oyugi et al 2004;Remien et al 2003;San Lio et al 2008;Tadios and Davey 2006;Weidle et al 2002;Weidle et al 2006;Weiser et al 2003) there has been little discussion about how HIV? women balance the demands of adherence to HIV ART, childcare, and antiretroviral adherence among their children who are HIV-infected.…”

Section: Introductionmentioning

confidence: 99%

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Longitudinal Antiretroviral Adherence in HIV+ Ugandan Parents and Their Children Initiating HAART in the MTCT-Plus Family Treatment Model: Role of Depression in Declining Adherence Over Time

et al. 2009

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We conducted a study to assess the effect of family-based treatment on adherence amongst HIV-infected parents and their HIV-infected children attending the Mother-To-Child-Transmission Plus program in Kampala, Uganda. Adherence was assessed using home-based pill counts and self-report. Mean adherence was over 94%. Depression was associated with incomplete adherence on multivariable analysis. Adherence declined over time. Qualitative interviews revealed lack of transportation money, stigma, clinical response to therapy, drug packaging, and cost of therapy may impact adherence. Our results indicate that providing ART to all eligible HIV-infected members in a household is associated with excellent adherence in both parents and children. Adherence to ART among new parents declines over time, even when patients receive treatment at no cost. Depression should be addressed as a potential barrier to adherence. Further study is necessary to assess the long-term impact of this family treatment model on adherence to ART in resource-limited settings.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Longitudinal Antiretroviral Adherence in HIV+ Ugandan Parents and Their Children Initiating HAART in the MTCT-Plus Family Treatment Model: Role of Depression in Declining Adherence Over Time

et al. 2009

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“…By contrast, patients in WHO stage 3 or 4 or with CD4 count <250 cells/mm 3 (eligible for ART) are seen in the relative luxury of a dedicated ART clinic with staff and services focused entirely on HIV/AIDS. Patients in stages 1 and 2 are thus unavoidably subjected to long waiting times, and in view of their relatively better health status (when compared with other ill patients with different ailments) probably come to be regarded as a second-class priority.…”

Section: Discussionmentioning

confidence: 99%

“…It has since shown that, using a simple standardised approach to ART delivery, treatment can be effectively delivered to large numbers of patients. 1,2 How-ever, the main focus has been on HIV-positive individuals eligible for ART either on the basis of clinical criteria (WHO clinical stage 3 or 4) or advanced immunodeficiency (CD4 cell count <250 cells/mm 3 ), and limited attention has been paid to individuals with less advanced disease who are not yet eligible for ART. This is because the national priority has understandably focused on individuals who are at relatively higher risk of HIV-related morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

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Unacceptable attrition among WHO stages 1 and 2 patients in a hospital-based setting in rural Malawi: can we retain such patients within the general health system?

Tayler‐Smith

Zachariah

Massaquoi

et al. 2010

Transactions of the Royal Society of Tropical Medicine and Hygi

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CitationUnacceptable attrition among WHO stages 1 and 2 patients in a hospital-based setting in rural Malawi: can we retain such patients within the general health system? 2010, 104 a b s t r a c tA study conducted among HIV-positive adults in WHO clinical stages 1 and 2 was followed up at Thyolo District Hospital (rural Malawi) to report on: (1) retention and attrition before and while on antiretroviral treatment (ART); and (2) the criteria used for initiating ART. Between June 2008 and January 2009, 1633 adults in WHO stages 1 and 2 were followed up for a total of 282 person-years. Retention in care at 1, 2, 3 and 6 months for those not on ART (n = 1078) was 25, 18, 11 and 4% vs. 99, 97, 95 and 90% for patients who started ART (n = 555, P = 0.001). Attrition rates were 31 times higher among patients not started on ART compared with those started on ART (adjusted hazard ratio, 31.0, 95% CI 22-44). Ninety-two patients in WHO stage 1 or 2 were started on ART without the guidance of a CD4 count, and 11 were incorrectly started on ART with CD4 count ≥250 cells/mm 3 . In a rural district hospital setting in Malawi, attrition of individuals in WHO stages 1 and 2 is unacceptably high, and specific operational strategies need to be considered to retain such patients in the health system.

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Treatment Failure and Mortality Factors in Patients Receiving Second-Line HIV Therapy in Resource-Limited Countries

Pujades-Rodríguez

Balkan²,

Arnould³

et al. 2010

JAMA

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Context Long-term antiretroviral therapy (ART) use in resource-limited countries leads to increasing numbers of patients with HIV taking second-line therapy. Limited access to further therapeutic options makes essential the evaluation of second-line regimen efficacy in these settings. Objectives To investigate failure rates in patients receiving second-line therapy and factors associated with failure and death. Design, Setting, and Participants Multicohort study of 632 patients Ͼ14 years old receiving second-line therapy for more than 6 months in 27 ART programs in Africa and Asia between January 2001 and October 2008. Main Outcome Measures Clinical, immunological, virological, and immunovirological failure (first diagnosed episode of immunological or virological failure) rates, and mortality after 6 months of second-line therapy use. Sensitivity analyses were performed using alternative CD4 cell count thresholds for immunological and immunovirological definitions of failure and for cohort attrition instead of death. Results The 632 patients provided 740.7 person-years of follow-up; 119 (18.8%) met World Health Organization failure criteria after a median 11.9 months following the start of second-line therapy (interquartile range [IQR], 8.7-17.0 months), and 34 (5.4%) died after a median 15.1 months (IQR, 11.9-25.7 months). Failure rates were lower in those who changed 2 nucleoside reverse transcriptase inhibitors (NRTIs) instead of 1 (179.2 vs 251.6 per 1000 person-years; incidence rate ratio [IRR], 0.64; 95% confidence interval [CI], 0.42-0.96), and higher in those with lowest adherence index (383.5 vs 176.0 per 1000 person-years; IRR, 3.14; 95% CI, 1.67-5.90 for Ͻ80% vs Ն95% [percentage adherent, as represented by percentage of appointments attended with no delay]). Failure rates increased with lower CD4 cell counts when second-line therapy was started, from 156.3 vs 96.2 per 1000 person-years; IRR, 1.59 (95% CI, 0.78-3.25) for 100 to 199/µL to 336.8 per 1000 person-years; IRR, 3.32 (95% CI, 1.81-6.08) for less than 50/µL vs 200/µL or higher; and decreased with time using second-line therapy, from 250.0 vs 123.2 per 1000 person-years; IRR, 1.90 (95% CI, 1.19-3.02) for 6 to 11 months to 212.0 per 1000 person-years; 1.71 (95% CI, 1.01-2.88) for 12 to 17 months vs 18 or more months. Mortality for those taking second-line therapy was lower in women (32.4 vs 68.3 per 1000 person-years; hazard ratio [HR], 0.45; 95% CI, 0.23-0.91); and higher in patients with treatment failure of any type (91.9 vs 28.1 per 1000 person-years; HR, 2.83; 95% CI, 1.38-5.80). Sensitivity analyses showed similar results. Conclusions Among patients in Africa and Asia receiving second-line therapy for HIV, treatment failure was associated with low CD4 cell counts at second-line therapy start, use of suboptimal second-line regimens, and poor adherence. Mortality was associated with diagnosed treatment failure.

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Assessment of a pilot antiretroviral drug therapy programme in Uganda: patients' response, survival, and drug resistance

Cited by 257 publications

References 16 publications

Longitudinal Antiretroviral Adherence in HIV+ Ugandan Parents and Their Children Initiating HAART in the MTCT-Plus Family Treatment Model: Role of Depression in Declining Adherence Over Time

Longitudinal Antiretroviral Adherence in HIV+ Ugandan Parents and Their Children Initiating HAART in the MTCT-Plus Family Treatment Model: Role of Depression in Declining Adherence Over Time

Unacceptable attrition among WHO stages 1 and 2 patients in a hospital-based setting in rural Malawi: can we retain such patients within the general health system?

Treatment Failure and Mortality Factors in Patients Receiving Second-Line HIV Therapy in Resource-Limited Countries

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