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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Discontinuation and modification of highly active antiretroviral therapy in HIV-infected Ugandans: Prevalence and associated factors
Journal of Acquired Immune Deficiency Syndromes, Volume 45, No. 2, Year 2007
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Description
BACKGROUND: Data on discontinuation and modification of highly active antiretroviral therapy (HAART) are scarce among sub-Saharan African populations. We sought to estimate the prevalence and to identify factors associated with these phenomena in our resource-limited setting. METHODS: Patients were recruited into this cross-sectional study from 2 treatment centers in Kampala, Uganda. Discontinuation and modification were assessed by self-report using semistructured quantitative and unstructured qualitative interviews. Discontinuation was defined as the simultaneous stopping of all antiretrovirals for at least 1 month, and modification as the changing of at least 1 antiretroviral used in an initial HAART regimen. Factors independently associated with each outcome were assessed using multivariate logistic regression. RESULTS: Of 686 subjects evaluated, 94 (13.7%) had ever discontinued therapy, whereas 175 (25.5%) had ever modified their regimen. The median CD4 count was 175 (interquartile range: 66-297) cells/μL. Factors associated with discontinuation were HAART experience before starting the current regimen (odds ratio [OR] = 3.70, 95% confidence interval [CI]: 2.13 to 6.25), use of alternative medicines (OR = 2.18, 95% CI: 1.06 to 4.47), hospitalization (OR = 2.36, 95% CI: 1.32 to 4.20), and 1 year or less on HAART (OR = 11.11, 95% CI: 5.00 to 25.00). Modification was associated with more than 3 months' duration on HAART (OR = 3.13, 95% CI: 1.16 to 8.33) and being unmarried (OR = 1.64, 95% CI: 1.02 to 2.70). CONCLUSIONS: The proportions of discontinuation and modification of antiretroviral therapy (ART) observed in our resource-poor setting pose a challenge to the limited treatment options presently available. Drug cost as a major reason for discontinuation of HAART has major implications for ART programs that charge fees in resource-limited settings. © 2007 Lippincott Williams & Wilkins, Inc.
Authors & Co-Authors
Kiguba, Ronald
Uganda, Kampala
School of Medicine, Makerere University College of Health Sciences
Byakika-Tusiime, Jayne
Uganda, Kampala
School of Medicine, Makerere University College of Health Sciences
Karamagi, Charles Amnon Sunday
Uganda, Kampala
School of Medicine, Makerere University College of Health Sciences
Ssali, Francis N.
Uganda, Kampala
Joint Clinical Research Center Uganda
Mugyenyi, Peter N.
Uganda, Kampala
Joint Clinical Research Center Uganda
Katabira, Elly Tebasoboke
Uganda, Kampala
School of Medicine, Makerere University College of Health Sciences
Statistics
Citations: 70
Authors: 6
Affiliations: 2
Identifiers
Doi:
10.1097/QAI.0b013e31805d8ae3
ISSN:
15254135
Research Areas
Infectious Diseases
Study Design
Cross Sectional Study
Case-Control Study
Study Approach
Qualitative
Quantitative
Study Locations
Uganda