Sub-optimal adherence to combination anti-retroviral therapy and its associated factors according to self-report, clinician-recorded and pharmacy-refill assessment methods among HIV-infected adults in Addis Ababa

Mekuria, Legese A.; Prins, Jan M.; Yalew, Alemayehu W.; Sprangers, Mirjam A. G.; Nieuwkerk, Pythia T.

doi:10.1080/09540121.2016.1234681

Cited by 13 publications

(12 citation statements)

References 34 publications

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“…Age may provide an explanation for some of the patient-level, regimen-specific, and structural factors associated with the absence of PI mutations and reduced adherence to second-line ART [ 26–29 ]. Social and structural obstacles to adherence can include inaccessible clinic location or lack of access to transportation, work/child care responsibilities, and low health care provider to patient ratio as a consequence of the rapid growth in ART roll-out programs [ 30 , 31 ]. Optimizing treatment adherence and retention at all stages in the cascade of HIV care is critical to the prevention of resistance.…”

Section: Discussionmentioning

confidence: 99%

HIV-1 Drug Resistance and Third-Line Therapy Outcomes in Patients Failing Second-Line Therapy in Zimbabwe

Chimbetete

Katzenstein

Shamu³

et al. 2018

Open Forum Infectious Diseases

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ObjectivesTo analyze the patterns and risk factors of HIV drug resistance mutations among patients failing second-line treatment and to describe early treatment responses to recommended third-line antiretroviral therapy (ART) in a national referral HIV clinic in Zimbabwe.MethodsPatients on boosted protease inhibitor (PI) regimens for more than 6 months with treatment failure confirmed by 2 viral load (VL) tests >1000 copies/mL were genotyped, and susceptibility to available antiretroviral drugs was estimated by the Stanford HIVdb program. Risk factors for major PI resistance were assessed by logistic regression. Third-line treatment was provided as Darunavir/r, Raltegravir, or Dolutegravir and Zidovudine, Abacavir Lamivudine, or Tenofovir.ResultsGenotypes were performed on 86 patients who had good adherence to treatment. The median duration of first- and second-line ART was 3.8 years (interquartile range [IQR], 2.3–5.1) and 2.6 years (IQR, 1.6–4.9), respectively. The median HIV viral load and CD4 cell count were 65 210 copies/mL (IQR, 8728–208 920 copies/mL) and 201 cells/mm3 (IQR, 49–333 cells/mm3). Major PI resistance-associated mutations (RAMs) were demonstrated in 44 (51%) non-nucleoside reverse transcriptase inhibitor RAMs in 72 patients (83%) and nucleoside reverse transcriptase inhibitors RAMs in 62 patients (72%). PI resistance was associated with age >24 years (P = .003) and CD4 cell count <200 cells/mm3 (P = .007). In multivariable analysis, only age >24 years was significantly associated (adjusted odds ratio, 4.75; 95% confidence interval, 1.69–13.38; P = .003) with major PI mutations. Third-line DRV/r- and InSTI-based therapy achieved virologic suppression in 29/36 patients (81%) after 6 months.ConclusionsThe prevelance of PI mutations was high. Adolescents and young adults had a lower risk of acquiring major PI resistance mutations, possibly due to poor adherence to ART. Third-line treatment with a regimen of Darunavir/r, Raltegravir/Dolutegravir, and optimized nucleoside reverse transcriptase inhibitors was effective.

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Section: Discussionmentioning

confidence: 99%

HIV-1 Drug Resistance and Third-Line Therapy Outcomes in Patients Failing Second-Line Therapy in Zimbabwe

Chimbetete

Katzenstein

Shamu³

et al. 2018

Open Forum Infectious Diseases

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“…Being treated in Addis Ababa was significantly associated with higher rates of transition compared to SNNPR. This might relate to the lower level of education in SNNPR and higher levels of poverty, HIV-stigma and discrimination [ 12 ], since education [ 9 ], poverty [ 26 , 27 ] and stigma [ 26 , 28 - 30 ] have previously been shown to be barriers of ART adherence in Ethiopia. However, these findings are on adult adherence and the relevance to adolescent transition remains to be settled.…”

Section: Discussionmentioning

confidence: 99%

“…Adherence levels in Ethiopia are generally high [ 9 ], but since only 67% of people living with HIV (PLHIV) are aware of their HIV-status, a mere 51% PLHIV in Ethiopia are virally suppressed [ 1 ], predisposing for spreading of the virus. ART has been suggested to be cost effective for use in Ethiopian district hospitals [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Transitioning from child to adult-oriented HIV clinical care for adolescents living with HIV in Ethiopia: results from a retrospective cohort study

Broström¹,

Andersson²,

Hallström³

et al. 2020

Pan Afr Med J

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Introduction Ethiopia has one of the largest number of adolescents living with HIV (ALHIV). As these adolescents reach adulthood they need to transfer from pediatric to adult-oriented clinics. Clear implementation guidelines for transition are lacking and factors associated with successful transition are inadequately investigated. Our objective was to describe the rate and age of transition from child- to adult-oriented care and the factors associated with transition success among ALHIV in selected health facilities in Ethiopia. Methods a retrospective cohort study of adolescents was conducted in eight health facilities in two regions of Ethiopia: Addis Ababa and the Southern Nations, Nationalities and Peoples´ Region (SNNPR). The study was embedded within a broader study originally aimed at studying clinical outcomes of adolescents. The proportion of adolescents who transitioned was calculated and the association between baseline characteristics and transition was assessed by bivariate and multivariate analysis. Results of 1072 adolescents, 8.7% transitioned to adult care. The most frequent age of transition was 15 (range: 10-22). Multivariate analysis generated two significant findings: adolescents from Addis Ababa were more to likely transitioned than adolescents from SNNPR (aOR: 2.18; 95% CI=1.17-4.06; p<0.01), as well as disclosed adolescents compared to those not disclosed of their HIV-status (aOR: 4.19; 95% CI=1.57-11.98; p<0.01). Conclusion transition occurred in less than 10% of participants, in a wide range of age, indicating a lack of implementation policies regarding the transition process. Thereto, we found that adolescents from Addis Ababa and those disclosed of their disease, were more likely to transition. Further studies are needed to better understand factors associated with transition success.

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“…In this study, individuals with a documentation of 'good' adherence at every visit in the last 6-months were categorized as having optimal adherence. Individuals with at least one clinician-recorded 'poor' or 'fair' adherence measures in any of the last 6-months [29] or individuals who missed ART refill follow-up for a period of �30 days between any of the last 6-months [30] were categorized as having sub-optimal adherence at 6-and 12-months.…”

Section: Variables and Measurementmentioning

confidence: 99%

Virologic outcomes of people living with human immunodeficiency virus who started antiretroviral treatment on the same-day of diagnosis in Ethiopia: A multicenter observational study

et al. 2021

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Introduction There have been tremendous achievements in scaling-up antiretroviral therapy (ART) for treatment of human immunodeficiency virus (HIV), following universal “test and treat” policy implementation in low- and middle-income countries. However, its effects on virologic outcomes is not yet well investigated. We compared low viral load status in people living with HIV between those who were initiated on ART on the same-day and after 7 days of being diagnosed with HIV infection. Methods We conducted a retrospective cohort study of persons age ≥15 years-old who were newly diagnosed and started on ART between October 2016 and July 2018 at 11 public health facilities in northwest Ethiopia. Exposure was initiation of ART on the same-day of HIV diagnosis. The outcome was low viral load at 12-months following ART initiation. We used double-robust estimator using inverse-probability-weighted regression adjustment to compare the groups. Results A total of 398 people who started ART on the same-day of HIV diagnosis and 479 people who started 7 days after the initial diagnosis were included in this study. By 12-months following ART initiation, 73.4% (292) in the same-day group vs 83.7% (401) in the >7 days group achieved low viral load (absolute difference = 10.3% (95% CI: 4.9%, 15.8%)). After adjusting for baseline and follow-up covariates, there was statistically significant difference in low viral load status (adjusted difference = 8.3% (95% CI: 3.5%, 13.0%)) between the same-day group and the >7 days group. Conclusions Achievement of low viral load by 12-months post-initiation of ART was not optimal among participants who started ART on the same-day of HIV diagnosis. Efforts should be made to reinforce treatment adherence while initiating same-day ART.

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Sub-optimal adherence to combination anti-retroviral therapy and its associated factors according to self-report, clinician-recorded and pharmacy-refill assessment methods among HIV-infected adults in Addis Ababa

Cited by 13 publications

References 34 publications

HIV-1 Drug Resistance and Third-Line Therapy Outcomes in Patients Failing Second-Line Therapy in Zimbabwe

HIV-1 Drug Resistance and Third-Line Therapy Outcomes in Patients Failing Second-Line Therapy in Zimbabwe

Transitioning from child to adult-oriented HIV clinical care for adolescents living with HIV in Ethiopia: results from a retrospective cohort study

Virologic outcomes of people living with human immunodeficiency virus who started antiretroviral treatment on the same-day of diagnosis in Ethiopia: A multicenter observational study

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