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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The use of pill counts as a facilitator of adherence with antiretroviral therapy in resource limited settings
PLoS ONE, Volume 8, No. 12, Article e67259, Year 2013
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Description
Background: Pill counts are often used to measure adherence to ART, but there is little data on how they affect adherence. We previously showed a bivariate relationship between clinicians counting pills and adherence in patients receiving HIV care in Kenya. We present a secondary analysis of the relationship between numbers of pill counts and clinical outcomes in resource limited settings Methods: Patients initiating ART at Kijabe Hospital were monitored for the number of discretionary pill counts performed by their clinician in the first 6 months of ART. Subjects were followed for at least 1 year after enrollment. The number of clinician pill counts was correlated to ART adherence. The primary endpoints were time to treatment failure, defined as a detectable HIV-1 viral load, death; or loss to follow-up. Results: Clinician pill counts were done at 68% of clinic visits for 304 subjects. There was a positive correlation between the number of clinician pill counts and ART adherence (r = 0.21, p <0.001). Patients were divided into 3 groups (0 counts, 1 to 3 counts, 4 to 7 counts) and exhibited adherence of 76%, 84%, and 92%, respectively (p = 0.004). Time to treatment failure for these groups was 220 days, 438 days, and 497 days (P<0.01), respectively. Time to virologic failure in living patients remaining in the cohort was longer in those with more pill count (P =0.02). Multi-variate analysis adjusting for co-variates affecting time to treatment failure found that that clinician pill counts were associated with a decreased risk of treatment failure (HR = 0.69, p =0.04). Conclusions: The number of clinician pill count performed was independently associated with better adherence and a decreased risk of treatment failure. The use of clinician pill counts should be further studied as an adherence promoter through a randomized clinical trial. © 2013 Achieng et al.
Authors & Co-Authors
Achieng, Loice
Kenya
A.i.c. Kijabe Hospital
Kenya, Nairobi
University of Nairobi
Musangi, Helen
Kenya, Nairobi
University of Nairobi
Billingsley, Katherine M.
United States, Galveston
The University of Texas Medical Branch at Galveston
Onguit, Sharon
United States, Galveston
The University of Texas Medical Branch at Galveston
Ombegoh, Edwin
Kenya
A.i.c. Kijabe Hospital
Bryant, Leeann
United States, Galveston
The University of Texas Medical Branch at Galveston
Mwiindi, Jonathan
United States, Galveston
The University of Texas Medical Branch at Galveston
Smith, Nathaniel
Kenya
A.i.c. Kijabe Hospital
United States, Little Rock
Arkansas Department of Health
Keiser, Philip H.
United States, Galveston
The University of Texas Medical Branch at Galveston
Statistics
Citations: 28
Authors: 9
Affiliations: 4
Identifiers
Doi:
10.1371/journal.pone.0067259
e-ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Randomised Control Trial
Cohort Study
Study Locations
Kenya