dc.contributor.author | Ochieng, W | |
dc.contributor.author | Kitawi, RC | |
dc.contributor.author | Nzomo, TJ | |
dc.contributor.author | Mwatelah, Ruth S | |
dc.contributor.author | Kimulwo, Maureen J | |
dc.contributor.author | Ochieng, Dorothy J. | |
dc.contributor.author | Kinyua, Joyceline | |
dc.contributor.author | Lagat, Nancy | |
dc.contributor.author | et.al | |
dc.date.accessioned | 2015-07-01T10:07:25Z | |
dc.date.available | 2015-07-01T10:07:25Z | |
dc.date.issued | 2015 | |
dc.identifier.citation | Ochieng, W., Kitawi, R. C., Nzomo, T. J., Mwatelah, R. S., Kimulwo, M. J., Ochieng, D. J., ... & Aman, R. (2015). Implementation and Operational Research: Correlates of Adherence and Treatment Failure Among Kenyan Patients on Long-term Highly Active Antiretroviral Therapy. JAIDS Journal of Acquired Immune Deficiency Syndromes, 69(2), e49-e56. | en_US |
dc.identifier.uri | http://journals.lww.com/jaids/Abstract/2015/06010/Implementation_and_Operational_Research__.19.aspx | |
dc.identifier.uri | http://hdl.handle.net/11295/85867 | |
dc.description.abstract | Background: Universal access to highly active antiretroviral therapy (HAART) is still elusive in most developing nations. We asked whether peer support influenced adherence and treatment outcome and if a single viral load (VL) could define treatment failure in a resource-limited setting.
Methods: A multicenter longitudinal and cross-sectional survey of VL, CD4 T cells, and adherence in 546 patients receiving HAART for up to 228 months. VL and CD4 counts were determined using m2000 Abbott RealTime HIV-1 assay and FACS counters, respectively. Adherence was assessed based on pill count and on self-report.
Results: Of the patients, 55.8%, 22.2%, and 22% had good, fair, and poor adherence, respectively. Adherence, peer support, and regimen, but not HIV disclosure, age, or gender, independently correlated with VL and durability of treatment in a multivariate analysis (P < 0.001). Treatment failure was 35.9% using sequential VL but ranged between 27% and 35% using alternate single VL cross-sectional definitions. More patients failed stavudine (41.2%) than zidovudine (37.4%) or tenofovir (28.8%, P = 0.043) treatment arms. Peer support correlated positively with adherence (χ2, P < 0.001), with nonadherence being highest in the stavudine arm. VL before the time of regimen switch was comparable between patients switching and not switching treatment. Moreover, 36% of those switching still failed the second-line regimen.
Conclusion: Weak adherence support and inaccessible VL testing threaten to compromise the success of HAART scale-up in Kenya. To hasten antiretroviral therapy monitoring and decision making, we suggest strengthening patient-focused adherence programs, optimizing and aligning regimen to WHO standards, and a single point-of-care VL testing when multiple tests are unavailable. | en_US |
dc.language.iso | en | en_US |
dc.title | Implementation and operational research: correlates of adherence and treatment failure among Kenyan patients on long-term highly active antiretroviral therapy | en_US |
dc.type | Article | en_US |
dc.type.material | en | en_US |