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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Predictors of incomplete adherence, virologic failure, and antiviral drug resistance among HIV-infected adults receiving antiretroviral therapy in Tanzania
Clinical Infectious Diseases, Volume 45, No. 11, Year 2007
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Description
Background. Access to antiretroviral therapy is rapidly expanding in sub-Saharan Africa. Identifying the predictors of incomplete adherence, virologic failure, and antiviral drug resistance is essential to achieving long-term success. Methods. A total of 150 subjects who had received antiretroviral therapy for at least 6 months completed a structured questionnaire and adherence assessment, and plasma human immunodeficiency virus (HIV) RNA levels were measured. Virologic failure was defined as an HIV RNA level >400 copies/mL; for patients with an HIV RNA level >1000 copies/mL, genotypic antiviral drug resistance testing was performed. Predictors were analyzed using bivariable and multivariable logistic regression models. Results. A total of 23 (16%) of 150 subjects reported incomplete adherence. Sacrificing health care for other necessities (adjusted odds ratio [AOR], 19.8; P < .01) and the proportion of months receiving self-funded treatment (AOR, 23.5; P = .04) were associated with incomplete adherence. Virologic failure was identified in 48 (32%) of 150 subjects and was associated with incomplete adherence (AOR, 3.6; P = .03) and the proportion of months receiving self-funded antiretroviral therapy (AOR, 13.0; P = .02). Disclosure of HIV infection status to family members or others was protective against virologic failure (AOR, 0.10; P = .04). Conclusions. Self-funded treatment was associated with incomplete adherence and virologic failure, and disclosure of HIV infection status was protective against virologic failure. Efforts to provide free antiretroviral therapy and to promote social coping may enhance adherence and reduce rates of virologic failure. © 2007 by the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Ramadhani, Habib Omari
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Thielman, Nathan M.
United States, Durham
Duke University Medical Center
Landman, Keren Z.
United States, Durham
Duke University Medical Center
Ndosi, Evaline M.
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Gao, Feng
United States, Durham
Duke University Medical Center
Kirchherr, Jennifer L.
United States, Durham
Duke University Medical Center
Shah, Rekha
United States, Durham
Duke University Medical Center
Shao, Humphrey J.
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Morpeth, Susan Claire
United States, Durham
Duke University Medical Center
McNeill, Jonathan D.
United States, Durham
Duke University Medical Center
Shao, John F.
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Tanzania, Moshi
Kilimanjaro Christian Medical University College
Bartlett, John A.
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Tanzania, Moshi
Kilimanjaro Christian Medical University College
United States, Durham
Duke University Medical Center
Crump, John A.
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Tanzania, Moshi
Kilimanjaro Christian Medical University College
United States, Durham
Duke University Medical Center
Statistics
Citations: 211
Authors: 13
Affiliations: 3
Identifiers
Doi:
10.1086/522991
ISSN:
10584838
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Case-Control Study
Study Locations
Tanzania