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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Impact of drug stock-outs on death and retention to care among HIV-infected patients on combination antiretroviral therapy in Abidjan, Côte d'ivoire
PLoS ONE, Volume 5, No. 10, Article e13414, Year 2010
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Description
Background: To evaluate the type and frequency of antiretroviral drug stock-outs, and their impact on death and interruption in care among HIV-infected patients in Abidjan, Côte d'Ivoire. Methods and Findings: We conducted a cohort study of patients who initiated combination antiretroviral therapy (cART) in three adult HIV clinics between February 1, 2006 and June 1, 2007. Follow-up ended on February 1, 2008. The primary outcome was cART regimen modification, defined as at least one drug substitution, or discontinuation for at least one month due to drug stock-outs at the clinic pharmacy. The secondary outcome for patients who were on cART for at least six months was interruption in care, or death. A Cox regression model with time-dependent variables was used to assess the impact of antiretroviral drug stock-outs on interruption in care or death. Overall, 1,554 adults initiated cART and were followed for a mean of 13.2 months. During this time, 72 patients discontinued treatment and 98 modified their regimen because of drug stock-outs. Stock-outs involved nevirapine and fixed-dose combination zidovudine/lamivudine in 27% and 51% of cases. Of 1,554 patients, 839 (54%) initiated cART with fixed-dose stavudine/lamivudine/nevirapine and did not face stock-outs during the study period. Among the 975 patients who were on cART for at least six months, stock-out-related cART discontinuations increased the risk of interruption in care or death (adjusted hazard ratio [HR], 2.83; 95%CI, 1.25-6.44) but cART modifications did not (adjusted HR, 1.21; 95%CI, 0.46-3.16). Conclusions: cART stock-outs affected at least 11% of population on treatment. Treatment discontinuations due to stockouts were frequent and doubled the risk of interruption in care or death. These stock-outs did not involve the most common first-line regimen. As access to cART continues to increase in sub-Saharan Africa, first-line regimens should be standardized to decrease the probability of drug stock-outs. © 2010 Pasquet et al.
Authors & Co-Authors
Pasquet, Armelle
France, Tourcoing
Centre Hospitalier de Tourcoing
Messou, Eugéne
Cote D'ivoire, Abidjan
Aconda
Gabillard, Delphine
France, Paris
Inserm
Minga, Albert Kla
France, Paris
Inserm
Cote D'ivoire, Abidjan
Programme Pac-ci
Depoulosky, Ayeby
Cote D'ivoire, Abidjan
Aconda
Deuffic-Burban, Sylvie
France, Lille
Institute for Translational Research in Inflammation Infinite
France, Lille
Evaluation Des Technologies de Santé et Des Pratiques Médicales Metrics
Losina, Elena
United States, Boston
Massachusetts General Hospital
Freedberg, Kenneth A.
United States, Boston
Massachusetts General Hospital
Danel, Christine
France, Paris
Inserm
Cote D'ivoire, Abidjan
Programme Pac-ci
Anglaret, Xavier
France, Paris
Inserm
Cote D'ivoire, Abidjan
Programme Pac-ci
Yazdanpanah, Yazdan
France, Tourcoing
Centre Hospitalier de Tourcoing
France, Lille
Evaluation Des Technologies de Santé et Des Pratiques Médicales Metrics
Statistics
Citations: 137
Authors: 11
Affiliations: 7
Identifiers
Doi:
10.1371/journal.pone.0013414
e-ISSN:
19326203
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Approach
Quantitative
Study Locations
Ivory Coast