Impact of drug stock-outs on death and retention to care among HIV-infected patients on combination antiretroviral therapy in Abidjan, Côte d'Ivoire

• Published in: PloS one 2010-10, Vol.5 (10), p.e13414-e13414
• Main Authors: Pasquet, Armelle, Messou, Eugène, Gabillard, Delphine, Minga, Albert, Depoulosky, Ayeby, Deuffic-Burban, Sylvie, Losina, Elena, Freedberg, Kenneth A, Danel, Christine, Anglaret, Xavier, Yazdanpanah, Yazdan
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; Adults; AIDS; Anti-HIV Agents - supply & distribution; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Clinical outcomes; Cote d'Ivoire - epidemiology; Death; Dependent variables; Drug therapy; Health care access; HIV; HIV Infections - drug therapy; HIV Infections - mortality; Human immunodeficiency virus; Humans; Infectious Diseases; Infectious Diseases/Epidemiology and Control of Infectious Diseases; Infectious Diseases/HIV Infection and AIDS; Interruption; Lamivudine; Mortality; Nevirapine; Patients; Pharmacy; Proportional Hazards Models; Regression models; Statistical analysis; Stavudine; Therapy; Tuberculosis; Zidovudine
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0013414

To evaluate the type and frequency of antiretroviral drug stock-outs, and their impact on death and interruption in care among HIV-infected patients in Abidjan, Côte d'Ivoire. We conducted a cohort study of patients who initiated combination antiretroviral therapy (cART) in three adult HIV clinics between February 1, 2006 and June 1, 2007. Follow-up ended on February 1, 2008. The primary outcome was cART regimen modification, defined as at least one drug substitution, or discontinuation for at least one month due to drug stock-outs at the clinic pharmacy. The secondary outcome for patients who were on cART for at least six months was interruption in care, or death. A Cox regression model with time-dependent variables was used to assess the impact of antiretroviral drug stock-outs on interruption in care or death. Overall, 1,554 adults initiated cART and were followed for a mean of 13.2 months. During this time, 72 patients discontinued treatment and 98 modified their regimen because of drug stock-outs. Stock-outs involved nevirapine and fixed-dose combination zidovudine/lamivudine in 27% and 51% of cases. Of 1,554 patients, 839 (54%) initiated cART with fixed-dose stavudine/lamivudine/nevirapine and did not face stock-outs during the study period. Among the 975 patients who were on cART for at least six months, stock-out-related cART discontinuations increased the risk of interruption in care or death (adjusted hazard ratio [HR], 2.83; 95%CI, 1.25-6.44) but cART modifications did not (adjusted HR, 1.21; 95%CI, 0.46-3.16). cART stock-outs affected at least 11% of population on treatment. Treatment discontinuations due to stock-outs were frequent and doubled the risk of interruption in care or death. These stock-outs did not involve the most common first-line regimen. As access to cART continues to increase in sub-Saharan Africa, first-line regimens should be standardized to decrease the probability of drug stock-outs.