Impact on adherence of a telephone follow up strategy in HIV‐naïve patients who start antiretroviral therapy: cohort study

Abstract

Antiretroviral therapy changed the prognosis of people living with HIV/AIDS. However, lack of adherence jeopardizes the success of antiretroviral therapy and enhances the development of treatment‐resistant strains, treatment failure, and therefore it stands as a public health problem. The main goal of this study was to measure the impact on treatment discontinuations and lost to follow up, of a telephone follow‐up strategy in naïve patients who start antiretroviral therapy. We conducted a single‐site, cohort study during a 12‐month period (May 2011–May 2012). A prospective cohort of naïve patients received the standard of care plus a specific telephone follow‐up strategy. Results were compared with a retrospective cohort of naïve patients followed up at the same site, who started antiretroviral therapy receiving only the standard of care during a similar period (January–December 2009). We used descriptive statistics and Fisher exact test for the comparisons of variables. We enrolled 41 patients in the prospective cohort and 50 in the retrospective one. Both cohorts had similar general characteristics. We found a lower number of patients who were lost to follow up in the prospective cohort (intervention) consistent with lower rates of treatment abandonment, suspensions and a similar tendency for events, including death, even when none of these findings was statistically significant. Baseline characteristics and main results are shown in the table below. Further randomized studies should be conducted applying a telephone follow‐up strategy to confirm these findings. Non intervention group (n: 50) Intervention Group (n: 41) p Age (mean in years)36350.58Women n (%)17 (34%)23 (56%)0.034Heterosexual n (%)33 (66%)28 (68%)0.81Education, years (mean)10.0210.390.58Preexistent serious disease6 (12%)5 (12%)1Previous opportunistic events (%)16 (32%)10 (24%)0.28Baseline CD4 count, median (range)176 (7–783)222 (20–868)0.12Baseline HIV RNA, log4.894.220.001Abandonment of treatment9 (18%)3 (7%)0.021Change of treatment10 (20%)14 (34%)0.042Lost to follow up23 (46%)10 (24%)0.032Hospitalization after HAART4 (8%)3 (7%)0.3New opportunistic event3 (6%)0 (0%)N/ADeath2 (4%)1 (2.4%)0.41CD4/mm3 at 24 weeks (median)3153840.151Log HIV RNA at 24 weeks (median)1.691.69