Socioeconomic and clinical factors explaining the risk of unstructured antiretroviral therapy interruptions among Kenyan adult patients

Mûnene, Edwin; Ekman, Björn

doi:10.1080/09540121.2016.1140890

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…These people are therefore likely to have NNRTI drug resistance. 33 , 34 , 35 Nevertheless, model outputs for the proportion of ART initiators with NNRTI pretreatment drug resistance who have previous antiretroviral drug exposure were not substantially higher than for those who have no previous antiretroviral drug exposure, which is in contrast with survey findings of pretreatment drug resistance that show markedly higher levels. This implies an even greater tendency for interruption of ART to be more likely in those with poor adherence than was assumed, which might imply that the policies just targeted at those with previous antiretroviral drug exposure could be more effective than we have shown.…”

Section: Discussionmentioning

confidence: 65%

Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: a modelling study

et al. 2018

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SummaryBackgroundThere is concern over increasing prevalence of non-nucleoside reverse-transcriptase inhibitor (NNRTI) resistance in people initiating antiretroviral therapy (ART) in low-income and middle-income countries. We assessed the effectiveness and cost-effectiveness of alternative public health responses in countries in sub-Saharan Africa where the prevalence of pretreatment drug resistance to NNRTIs is high.MethodsThe HIV Synthesis Model is an individual-based simulation model of sexual HIV transmission, progression, and the effect of ART in adults, which is based on extensive published data sources and considers specific drugs and resistance mutations. We used this model to generate multiple setting scenarios mimicking those in sub-Saharan Africa and considered the prevalence of pretreatment NNRTI drug resistance in 2017. We then compared effectiveness and cost-effectiveness of alternative policy options. We took a 20 year time horizon, used a cost effectiveness threshold of US$500 per DALY averted, and discounted DALYs and costs at 3% per year.FindingsA transition to use of a dolutegravir as a first-line regimen in all new ART initiators is the option predicted to produce the most health benefits, resulting in a reduction of about 1 death per year per 100 people on ART over the next 20 years in a situation in which more than 10% of ART initiators have NNRTI resistance. The negative effect on population health of postponing the transition to dolutegravir increases substantially with higher prevalence of HIV drug resistance to NNRTI in ART initiators. Because of the reduced risk of resistance acquisition with dolutegravir-based regimens and reduced use of expensive second-line boosted protease inhibitor regimens, this policy option is also predicted to lead to a reduction of overall programme cost.InterpretationA future transition from first-line regimens containing efavirenz to regimens containing dolutegravir formulations in adult ART initiators is predicted to be effective and cost-effective in low-income settings in sub-Saharan Africa at any prevalence of pre-ART NNRTI resistance. The urgency of the transition will depend largely on the country-specific prevalence of NNRTI resistance.FundingBill & Melinda Gates Foundation, World Health Organization.

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Section: Discussionmentioning

confidence: 65%

Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: a modelling study

et al. 2018

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“…Not only does the relationship with HCP affect adherence/non-adherence, but also socioeconomic factors such as higher income, occupation, education level, and disease-related factors such as more symptoms and the duration of ART. Studies have shown regional distinctions in the impact of these different factors, which seem to play a decisive role in African countries [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Involvement, Perception, and Understanding as Determinants for Patient–Physician Relationship and Their Association with Adherence: A Questionnaire Survey among People Living with HIV and Antiretroviral Therapy in Austria

Beichler

Grabovac

Leichsenring³

et al. 2022

IJERPH

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Background: The relationship between patients and healthcare professionals (physicians) is the cornerstone of successful long-term antiretroviral therapy for people living with human immunodeficiency virus (HIV). Purpose: This study aimed to investigate the connection between involvement, perception, and understanding as the basis for the patient–physician relationship and drug adherence, measured as the probability of non-adherence. Methods: In an online survey, people with HIV were asked about their relationship with their physicians and the extent to which they felt involved in treatment-related decisions. A statistical analysis was conducted to determine whether a better patient–physician relationship was associated with higher adherence to therapy. This was performed by univariate group comparison (Mann–Whitney-U, Fishers Exact Test) and logistic regression. Results: A total of 303 persons living with HIV participated in the survey, and 257 patients were included in the analysis. Overall, 27.6% were classified as non-adherent and self-reporting based on whether an antiretroviral therapy (ART) was taken in the past or how often the ART was interrupted. This proportion was significantly higher among patients aged 50–74 years (39.7%) and those with a longer therapy duration (9–15 years: 46.6%; from 15 years on: 55.8%). Therapy-non-adherent patients showed significantly lower scores in the relationship aspects understanding (2.68 vs. 3.03), participation (2.63 vs. 3.07), and perception (3.00 vs. 3.24) compared to adherent patients. Logistic regression analysis confirms that higher scores for understanding, involvement, and perception are strongly associated with a reduction in the risk of becoming non-adherent. This was true for all examined regression models, regardless of whether they were adjusted for the length of therapy and socio-demographic characteristics. Conclusion: The results reinforce the need for awareness among health care professionals (HCP) regarding understanding, involvement, and perception as important aspects to improve the quality of the patient–physician relationship for high adherence levels with maximized non-adherence in ART management by PLWH.

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“…The model is not applicable to situations where a patient does not have continuous access to ARVs. Lack of access might occur for reasons of pharmacy stock shortages, individual resource constraints, or other circumstances [ 20 , 21 ].…”

Section: Methodsmentioning

confidence: 99%

Predicting short-term interruptions of antiretroviral therapy from summary adherence data: Development and test of a probability model

et al. 2018

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Antiretroviral therapy (ART) for HIV is vulnerable to unplanned treatment interruptions–consecutively missed doses over a series of days–which can result in virologic rebound. Yet clinicians lack a simple, valid method for estimating the risk of interruptions. If the likelihood of ART interruption could be derived from a convenient-to-gather summary measure of medication adherence, it might be a valuable tool for both clinical decision-making and research. We constructed an a priori probability model of ART interruption based on average adherence and tested its predictions using data collected on 185 HIV-infected, treatment-naïve individuals over the first 90 days of ART in a prospective cohort study in Mbarara, Uganda. The outcome of interest was the presence or absence of a treatment gap, defined as >72 hours without a dose. Using the pre-determined value of 0.50 probability as the cut point for predicting an interruption, the classification accuracy of the model was 73% (95% CI = 66%– 79%), the specificity was 87% (95% CI = 79%– 93%), and the sensitivity was 59% (95% CI = 48%– 69%). Overall model performance was satisfactory, with an area under the receiver operator characteristic curve (AUROC) of 0.85 (95% CI = 0.80–0.91) and Brier score of 0.20. The study serves as proof-of-concept that the probability model can accurately differentiate patients on the continuum of risk for short-term ART interruptions using a summary measure of adherence. The model may also aid in the design of targeted interventions.

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Socioeconomic and clinical factors explaining the risk of unstructured antiretroviral therapy interruptions among Kenyan adult patients

Cited by 3 publications

References 27 publications

Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: a modelling study

Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: a modelling study

Involvement, Perception, and Understanding as Determinants for Patient–Physician Relationship and Their Association with Adherence: A Questionnaire Survey among People Living with HIV and Antiretroviral Therapy in Austria

Predicting short-term interruptions of antiretroviral therapy from summary adherence data: Development and test of a probability model

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