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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Revisiting long-term adherence to highly active antiretroviral therapy in senegal using latent class analysis
Journal of Acquired Immune Deficiency Syndromes, Volume 57, No. 1, Year 2011
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Description
Background: Adherence is one of the main predictors of antiretroviral treatment success. A governmental initiative was launched in 1998 for HIV-infected patients in Senegal to provide access to highly active antiretroviral therapy. Methods: Between August 1998 and April 2002, 404 adult patients were enrolled. Adherence measurements, defined as pills taken/pills prescribed, were assessed between November 1999 and April 2009 using a pill count along with a questionnaire for 330 patients. Predictors of adherence were explored through a random-intercept Tobit model and a latent class analysis (LCA) was performed to identify adherence trajectories. We also performed a survival analysis taking into account gender and latent adherence classes. Results: Median treatment duration was 91 months (interquartile range, 84-101). On average, adherence declined by 7% every year, was 30% lower for patients taking indinavir, and 12% higher for those receiving cotrimoxazole prophylaxis. Based on the predicted probability of having an adherence ≥ 95%, LCA revealed 3 adherence behaviors and a better adherence for women. A quarter of patients had a high adherence trajectory over time and half had an intermediate one. Male gender and low adherence behavior over time were independently associated with a higher mortality rate. Conclusions: This study shows that an overall good adherence can be obtained in the long term in Senegal. LCA suggests a better adherence for women and points out a large subsample of patients with intermediate level of adherence behavior who are at risk for developing resistance to antiretroviral drugs. This study warrants further research into gender issues. © 2011 by Lippincott Williams and Wilkins.
Authors & Co-Authors
Bastard, Mathieu
France, Lyon
Chu de Lyon
France, Lyon
Université de Lyon
France, Villeurbanne
Université Claude Bernard Lyon 1
France, Villeurbanne
Laboratoire de Biométrie et Biologie Évolutive
France, Paris
Epicentre
Fall, Mame Basty Koita
Senegal, Dakar
Centre Hospitalier Universitaire Dakar
Laniéce, Isabelle
Senegal, Dakar
Centre Hospitalier Universitaire Dakar
Taverne, Bernard
France, Montpellier
Ird Centre de Montpellier
Desclaux, Alice
France, Paris
Epicentre
Écochard, René
France, Lyon
Chu de Lyon
France, Lyon
Université de Lyon
France, Villeurbanne
Université Claude Bernard Lyon 1
France, Villeurbanne
Laboratoire de Biométrie et Biologie Évolutive
Sow, Papa Salif
Senegal, Dakar
Centre Hospitalier Universitaire Dakar
Delaporte, Éric
France, Montpellier
Ird Centre de Montpellier
Étard, Jean François
France, Montpellier
Ird Centre de Montpellier
Statistics
Citations: 41
Authors: 9
Affiliations: 7
Identifiers
Doi:
10.1097/QAI.0b013e318211b43b
ISSN:
15254135
Research Areas
Health System And Policy
Infectious Diseases
Study Locations
Senegal
Participants Gender
Male
Female