Optimal antiretroviral therapy adherence as evaluated by CASE index score tool is associated with virological suppression in HIV‐infected adults in Dakar, Senegal

Objective To determine the prevalence and factors associated with optimal antiretroviral therapy (ART) adherence and virological failure (VLF) among HIV‐infected adults enrolled in the national ART programme at the teaching hospital of Fann, Dakar, Senegal. Methods Cross‐sectional study from 1 Septe...

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Bibliographic Details
Published in:Tropical medicine & international health 2017-06, Vol.22 (6), p.776-782
Main Authors: Byabene, A. K., Fortes‐Déguénonvo, L., Niang, K., Manga, M. N., Bulabula, A. N. H., Nachega, J. B., Seydi, M.
Format: Article
Language:English
Subjects:
adherence
adherencia
adhésion
Adult
Anti-HIV Agents - therapeutic use
antiretroviral therapy
CASE Index Score
CD4 Lymphocyte Count
Cross-Sectional Studies
Escala CASE
fallo virológico
Female
HIV
HIV Infections - drug therapy
Humans
Logistic Models
Male
Medication Adherence
Middle Aged
Senegal
Surveys and Questionnaires
Sénégal
terapia antirretroviral
traitement antirétroviral
VIH
Viral Load
virological failure
échec virologique
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Summary:Objective To determine the prevalence and factors associated with optimal antiretroviral therapy (ART) adherence and virological failure (VLF) among HIV‐infected adults enrolled in the national ART programme at the teaching hospital of Fann, Dakar, Senegal. Methods Cross‐sectional study from 1 September 2013 to 30 January 2014. Outcomes: (1) optimal ART adherence by the Center for Adherence Support Evaluation (CASE) Index Score (>10) and (2) VLF (HIV RNA > 1000 copies/ml). Diagnostic accuracy of CASE Index Score assessed using sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and corresponding 95% confidence intervals (CIs). Multivariate logistic regression analysis was performed to identify independent factors associated with optimal adherence and VLF. Results Of 98 HIV‐infected patients on ART, 68% were female. The median (IQR) age was 42 (20–50) years. A total of 57 of 98 (60%) were on ART more than 3 years, and majority (88%) were on NNRTI‐based first‐line ART regimen. A total of 79 of 98 (80%) patients reported optimal ART adherence, and only five of 84 (5.9%) had documented VLF. Patients with VLF were significantly more likely to have suboptimal ART adherence (17.7% vs. 2.9%; P = 0.02). CASE Index Score showed the best trade‐off in Se (78.9%, 95% CI: 54.4–93.9%), Sp (20.0%, 95% CI: 11.1–31.7), PPV (22.4, 95% CI: 13.1–34.2%) and NPV (76.5%, 95% CI: 50.1–93.2), when used VLF threshold of HIV RNA >50 copies/ml. Factors independently associated with VLF were CASE Index Score
ISSN:1360-2276
1365-3156
DOI:10.1111/tmi.12882