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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Adherence to first-line antiretroviral therapy affects non-virologic outcomes among patients on treatment for more than 12 months in Lusaka, Zambia
International Journal of Epidemiology, Volume 38, No. 3, Year 2009
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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 (<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. © Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2009; all rights reserved.
Authors & Co-Authors
Chi, Benjamin H.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Cantrell, Ronald A.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Zulu, Isaac S.
United States, Atlanta
Centers for Disease Control and Prevention
Zambia, Lusaka
University of Zambia School of Medicine
Mulenga, Lloyd Berdad
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Levy, Jens W.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Tambatamba, Bushimbwa
Zambia, Lusaka
Zambian Ministry of Health
Reid, Stewart E.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Mwango, Albert J.
Zambia, Lusaka
Zambian Ministry of Health
Mwinga, Alwyn G.
United States, Atlanta
Centers for Disease Control and Prevention
Bulterys, Marc G.
United States, Atlanta
Centers for Disease Control and Prevention
Saag, Michael S.
United States, Birmingham
The University of Alabama at Birmingham
Stringer, Jeffrey S.A.
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
United States, Birmingham
The University of Alabama at Birmingham
Statistics
Citations: 116
Authors: 12
Affiliations: 5
Identifiers
Doi:
10.1093/ije/dyp004
ISSN:
03005771
e-ISSN:
14643685
Research Areas
Environmental
Health System And Policy
Study Design
Cohort Study
Study Locations
Zambia