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Adherence to first-line antiretroviral therapy affects non-virologic outcomes among patients on treatment for more than 12 months in Lusaka, Zambia
Background High-level adherence to antiretroviral therapy (ART) is associated with favourable patient outcomes. In resource-constrained settings, however, there are few validated measures. We examined the correlation between clinical outcomes and the medication possession ratio (MPR), a pharmacy-bas...
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| Published in: | International journal of epidemiology 2009-06, Vol.38 (3), p.746-756 |
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| creator | Chi, Benjamin H Cantrell, Ronald A Zulu, Isaac Mulenga, Lloyd B Levy, Jens W Tambatamba, Bushimbwa C Reid, Stewart Mwango, Albert Mwinga, Alwyn Bulterys, Marc Saag, Michael S Stringer, Jeffrey SA |
| description | Background High-level adherence to antiretroviral therapy (ART) is associated with favourable patient outcomes. In resource-constrained settings, however, there are few validated measures. We examined the correlation between clinical outcomes and the medication possession ratio (MPR), a pharmacy-based measure of adherence. Methods We analysed data from a large programmatic cohort across 18 primary care centres providing ART in Lusaka, Zambia. Patients were stratified into three categories based on MPR-calculated adherence over the first 12 months: optimal (≥95%), suboptimal (80–94%) and poor ( |
| doi_str_mv | 10.1093/ije/dyp004 |
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In resource-constrained settings, however, there are few validated measures. We examined the correlation between clinical outcomes and the medication possession ratio (MPR), a pharmacy-based measure of adherence. Methods We analysed data from a large programmatic cohort across 18 primary care centres providing ART in Lusaka, Zambia. Patients were stratified into three categories based on MPR-calculated adherence over the first 12 months: optimal (≥95%), suboptimal (80–94%) and poor (<80%). Results Overall, 27 115 treatment-naïve adults initiated and continued ART for ≥12 months: 17 060 (62.9%) demonstrated optimal adherence, 7682 (28.3%) had suboptimal adherence and 2373 (8.8%) had poor adherence. When compared with those with optimal adherence, post-12-month mortality risk was similar among patients with sub-optimal adherence [adjusted hazard ratio (AHR) = 1.0; 95% CI: 0.9–1.2] but higher in patients with poor adherence (AHR = 1.7; 95% CI: 1.4–2.2). Those <80% MPR also appeared to have an attenuated CD4 response at 18 months (185 cells/µl vs 217 cells/µl; P < 0.001), 24 months (213 cells/µl vs 246 cells/µl; P < 0.001), 30 months (226 cells/µl vs 261 cells/µl; P < 0.001) and 36 months (245 cells/µl vs 275 cells/µl; P < 0.01) when compared with those above this threshold. Conclusions MPR was predictive of clinical outcomes and immunologic response in this large public sector antiretroviral treatment program. This marker may have a role in guiding programmatic monitoring and clinical care in resource-constrained settings.]]></description><identifier>ISSN: 0300-5771</identifier><identifier>EISSN: 1464-3685</identifier><identifier>DOI: 10.1093/ije/dyp004</identifier><identifier>PMID: 19223334</identifier><identifier>CODEN: IJEPBF</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>adherence ; Adolescent ; Adult ; Africa ; Anti-HIV Agents - therapeutic use ; antiretroviral therapy ; Antiretroviral Therapy, Highly Active ; Biological and medical sciences ; CD4-Positive T-Lymphocytes ; Female ; HIV ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; HIV-1 ; Human viral diseases ; Humans ; Infectious Disease ; Infectious diseases ; Male ; Medical sciences ; Medication Adherence - statistics & numerical data ; medication possession ratio ; Medication Therapy Management - statistics & numerical data ; Middle Aged ; Miscellaneous ; mortality ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; survival ; Time Factors ; Urban Health ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids ; Young Adult ; Zambia ; Zambia - epidemiology</subject><ispartof>International journal of epidemiology, 2009-06, Vol.38 (3), p.746-756</ispartof><rights>Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2009; all rights reserved. 2009</rights><rights>2009 INIST-CNRS</rights><rights>Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2009; all rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c532t-b0f9532b64a20db76260904725618367b4bb533a8fa0a2fed2d76b2c9313e1b13</citedby><cites>FETCH-LOGICAL-c532t-b0f9532b64a20db76260904725618367b4bb533a8fa0a2fed2d76b2c9313e1b13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21694162$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19223334$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chi, Benjamin H</creatorcontrib><creatorcontrib>Cantrell, Ronald A</creatorcontrib><creatorcontrib>Zulu, Isaac</creatorcontrib><creatorcontrib>Mulenga, Lloyd B</creatorcontrib><creatorcontrib>Levy, Jens W</creatorcontrib><creatorcontrib>Tambatamba, Bushimbwa C</creatorcontrib><creatorcontrib>Reid, Stewart</creatorcontrib><creatorcontrib>Mwango, Albert</creatorcontrib><creatorcontrib>Mwinga, Alwyn</creatorcontrib><creatorcontrib>Bulterys, Marc</creatorcontrib><creatorcontrib>Saag, Michael S</creatorcontrib><creatorcontrib>Stringer, Jeffrey SA</creatorcontrib><title>Adherence to first-line antiretroviral therapy affects non-virologic outcomes among patients on treatment for more than 12 months in Lusaka, Zambia</title><title>International journal of epidemiology</title><addtitle>Int J Epidemiol</addtitle><description><![CDATA[Background High-level adherence to antiretroviral therapy (ART) is associated with favourable patient outcomes. In resource-constrained settings, however, there are few validated measures. We examined the correlation between clinical outcomes and the medication possession ratio (MPR), a pharmacy-based measure of adherence. Methods We analysed data from a large programmatic cohort across 18 primary care centres providing ART in Lusaka, Zambia. Patients were stratified into three categories based on MPR-calculated adherence over the first 12 months: optimal (≥95%), suboptimal (80–94%) and poor (<80%). Results Overall, 27 115 treatment-naïve adults initiated and continued ART for ≥12 months: 17 060 (62.9%) demonstrated optimal adherence, 7682 (28.3%) had suboptimal adherence and 2373 (8.8%) had poor adherence. When compared with those with optimal adherence, post-12-month mortality risk was similar among patients with sub-optimal adherence [adjusted hazard ratio (AHR) = 1.0; 95% CI: 0.9–1.2] but higher in patients with poor adherence (AHR = 1.7; 95% CI: 1.4–2.2). Those <80% MPR also appeared to have an attenuated CD4 response at 18 months (185 cells/µl vs 217 cells/µl; P < 0.001), 24 months (213 cells/µl vs 246 cells/µl; P < 0.001), 30 months (226 cells/µl vs 261 cells/µl; P < 0.001) and 36 months (245 cells/µl vs 275 cells/µl; P < 0.01) when compared with those above this threshold. Conclusions MPR was predictive of clinical outcomes and immunologic response in this large public sector antiretroviral treatment program. This marker may have a role in guiding programmatic monitoring and clinical care in resource-constrained settings.]]></description><subject>adherence</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Africa</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>antiretroviral therapy</subject><subject>Antiretroviral Therapy, Highly Active</subject><subject>Biological and medical sciences</subject><subject>CD4-Positive T-Lymphocytes</subject><subject>Female</subject><subject>HIV</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>HIV-1</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Infectious Disease</subject><subject>Infectious diseases</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medication Adherence - statistics & numerical data</subject><subject>medication possession ratio</subject><subject>Medication Therapy Management - statistics & numerical data</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>mortality</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>survival</subject><subject>Time Factors</subject><subject>Urban Health</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. Aids</subject><subject>Young Adult</subject><subject>Zambia</subject><subject>Zambia - epidemiology</subject><issn>0300-5771</issn><issn>1464-3685</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNqF0s2O0zAQAGALgdhSuPAAyEKCAyKs_-okF6TVCiioEgeWH-3FmjhO625iB9tZ0efghfGqVRc4wMkezacZezQIPabkFSU1P7Vbc9ruRkLEHTSjQoqCy2pxF80IJ6RYlCU9QQ9i3BJChRD1fXRCa8Y452KGfp61GxOM0wYnjzsbYip66wwGl2wwKfhrG6DHKSsYdxi6zugUsfOuyBnf-7XV2E9J-8FEDIN3azxCssZl5R1OwUAacoQ7H_DgQ260AYcpy4FLm4itw6spwhW8xJcwNBYeonsd9NE8Opxz9Pntm4vzZbH6-O79-dmq0AvOUtGQrs6XRgpgpG1KySSpiSjZQtKKy7IRTbPgHKoOCLDOtKwtZcN0zSk3tKF8jl7v645TM5hW50fmr6ox2AHCTnmw6s-Msxu19teKyarmufccPT8UCP77ZGJSg43a9D0446eoZMmpKCvxX8hIVXFeywyf_gW3fgouT0ExWlNZlbTO6MUe6eBjDKY7PpkSdbMRKm-E2m9Exk9-_-QtPaxABs8OAKKGvgvgtI1Hx6isBZXs1vlp_HfDYu9sTObHUUK4uplHuVDLb5dq-WV18elD9VVR_gsWad3F</recordid><startdate>20090601</startdate><enddate>20090601</enddate><creator>Chi, Benjamin H</creator><creator>Cantrell, Ronald A</creator><creator>Zulu, Isaac</creator><creator>Mulenga, Lloyd B</creator><creator>Levy, Jens W</creator><creator>Tambatamba, Bushimbwa C</creator><creator>Reid, Stewart</creator><creator>Mwango, Albert</creator><creator>Mwinga, Alwyn</creator><creator>Bulterys, Marc</creator><creator>Saag, Michael S</creator><creator>Stringer, Jeffrey SA</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QP</scope><scope>7QR</scope><scope>7T2</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7U1</scope><scope>7U2</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20090601</creationdate><title>Adherence to first-line antiretroviral therapy affects non-virologic outcomes among patients on treatment for more than 12 months in Lusaka, Zambia</title><author>Chi, Benjamin H ; Cantrell, Ronald A ; Zulu, Isaac ; Mulenga, Lloyd B ; Levy, Jens W ; Tambatamba, Bushimbwa C ; Reid, Stewart ; Mwango, Albert ; Mwinga, Alwyn ; Bulterys, Marc ; Saag, Michael S ; Stringer, Jeffrey SA</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c532t-b0f9532b64a20db76260904725618367b4bb533a8fa0a2fed2d76b2c9313e1b13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>adherence</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Africa</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>antiretroviral therapy</topic><topic>Antiretroviral Therapy, Highly Active</topic><topic>Biological and medical sciences</topic><topic>CD4-Positive T-Lymphocytes</topic><topic>Female</topic><topic>HIV</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - epidemiology</topic><topic>HIV-1</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Infectious Disease</topic><topic>Infectious diseases</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medication Adherence - statistics & numerical data</topic><topic>medication possession ratio</topic><topic>Medication Therapy Management - statistics & numerical data</topic><topic>Middle Aged</topic><topic>Miscellaneous</topic><topic>mortality</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>survival</topic><topic>Time Factors</topic><topic>Urban Health</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. Aids</topic><topic>Young Adult</topic><topic>Zambia</topic><topic>Zambia - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chi, Benjamin H</creatorcontrib><creatorcontrib>Cantrell, Ronald A</creatorcontrib><creatorcontrib>Zulu, Isaac</creatorcontrib><creatorcontrib>Mulenga, Lloyd B</creatorcontrib><creatorcontrib>Levy, Jens W</creatorcontrib><creatorcontrib>Tambatamba, Bushimbwa C</creatorcontrib><creatorcontrib>Reid, Stewart</creatorcontrib><creatorcontrib>Mwango, Albert</creatorcontrib><creatorcontrib>Mwinga, Alwyn</creatorcontrib><creatorcontrib>Bulterys, Marc</creatorcontrib><creatorcontrib>Saag, Michael S</creatorcontrib><creatorcontrib>Stringer, Jeffrey SA</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Chemoreception Abstracts</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chi, Benjamin H</au><au>Cantrell, Ronald A</au><au>Zulu, Isaac</au><au>Mulenga, Lloyd B</au><au>Levy, Jens W</au><au>Tambatamba, Bushimbwa C</au><au>Reid, Stewart</au><au>Mwango, Albert</au><au>Mwinga, Alwyn</au><au>Bulterys, Marc</au><au>Saag, Michael S</au><au>Stringer, Jeffrey SA</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adherence to first-line antiretroviral therapy affects non-virologic outcomes among patients on treatment for more than 12 months in Lusaka, Zambia</atitle><jtitle>International journal of epidemiology</jtitle><addtitle>Int J Epidemiol</addtitle><date>2009-06-01</date><risdate>2009</risdate><volume>38</volume><issue>3</issue><spage>746</spage><epage>756</epage><pages>746-756</pages><issn>0300-5771</issn><eissn>1464-3685</eissn><coden>IJEPBF</coden><abstract><![CDATA[Background High-level adherence to antiretroviral therapy (ART) is associated with favourable patient outcomes. In resource-constrained settings, however, there are few validated measures. We examined the correlation between clinical outcomes and the medication possession ratio (MPR), a pharmacy-based measure of adherence. Methods We analysed data from a large programmatic cohort across 18 primary care centres providing ART in Lusaka, Zambia. Patients were stratified into three categories based on MPR-calculated adherence over the first 12 months: optimal (≥95%), suboptimal (80–94%) and poor (<80%). Results Overall, 27 115 treatment-naïve adults initiated and continued ART for ≥12 months: 17 060 (62.9%) demonstrated optimal adherence, 7682 (28.3%) had suboptimal adherence and 2373 (8.8%) had poor adherence. When compared with those with optimal adherence, post-12-month mortality risk was similar among patients with sub-optimal adherence [adjusted hazard ratio (AHR) = 1.0; 95% CI: 0.9–1.2] but higher in patients with poor adherence (AHR = 1.7; 95% CI: 1.4–2.2). Those <80% MPR also appeared to have an attenuated CD4 response at 18 months (185 cells/µl vs 217 cells/µl; P < 0.001), 24 months (213 cells/µl vs 246 cells/µl; P < 0.001), 30 months (226 cells/µl vs 261 cells/µl; P < 0.001) and 36 months (245 cells/µl vs 275 cells/µl; P < 0.01) when compared with those above this threshold. Conclusions MPR was predictive of clinical outcomes and immunologic response in this large public sector antiretroviral treatment program. This marker may have a role in guiding programmatic monitoring and clinical care in resource-constrained settings.]]></abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>19223334</pmid><doi>10.1093/ije/dyp004</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | International journal of epidemiology, 2009-06, Vol.38 (3), p.746-756 |
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| source | Oxford Journals Online |
| subjects | adherence Adolescent Adult Africa Anti-HIV Agents - therapeutic use antiretroviral therapy Antiretroviral Therapy, Highly Active Biological and medical sciences CD4-Positive T-Lymphocytes Female HIV HIV Infections - drug therapy HIV Infections - epidemiology HIV-1 Human viral diseases Humans Infectious Disease Infectious diseases Male Medical sciences Medication Adherence - statistics & numerical data medication possession ratio Medication Therapy Management - statistics & numerical data Middle Aged Miscellaneous mortality Public health. Hygiene Public health. Hygiene-occupational medicine survival Time Factors Urban Health Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids Young Adult Zambia Zambia - epidemiology |
| title | Adherence to first-line antiretroviral therapy affects non-virologic outcomes among patients on treatment for more than 12 months in Lusaka, Zambia |
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