Who’s slipping through the cracks? A comprehensive individual, clinical, and health system characterization of people with virologic failure on first-line HIV treatment in Uganda and South Africa
| Autor: | Winnie Muyindike, Vincent C. Marconi, Tamlyn Rautenberg, Henry Sunpath, Jaysingh Brijkumar, Mwebesa Bwana, Zahra Reynolds, Gavin George, Godfrey Masette, Selvan Pillay, Mark J. Siedner, Suzanne M. McCluskey, Rajesh T. Gandhi, Mahomed Yunus S. Moosa, Rebecca F Gilbert, Pravi Moodley, Isaac Aturinda, Kevin L. Ard, Nicholas Musinguzi, Brent A. Johnson |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Pediatrics medicine.medical_specialty Anti-HIV Agents Population Psychological intervention HIV Infections Drug resistance Article South Africa Interquartile range Health care Drug Resistance Viral Medicine Humans Pharmacology (medical) Uganda Treatment Failure education education.field_of_study business.industry Health Policy Viral Load Confidence interval CD4 Lymphocyte Count Infectious Diseases Cohort Female business HIV drug resistance |
| Zdroj: | HIV Med |
| Popis: | Objectives: HIV virological failure remains a major threat to programme success in sub-Saharan Africa. While HIV drug resistance (HIVDR) and inadequate adherence are the main drivers of virological failure, the individual, clinical and health system characteristics that lead to poor outcomes are not well understood. The objective of this paper is to identify those characteristics among people failing first-line antiretroviral therapy (ART). Methods: We enrolled a cohort of adults in HIV care experiencing virological failure on first-line ART at five sites and used standard statistical methods to characterize them with a focus on three domains: individual/demographic, clinical, and health system, and compared each by country of enrolment. Results: Of 840 participants, 51% were women, the median duration on ART was 3.2 years [interquartile range (IQR) 1.1, 6.4 years] and the median CD4 cell count prior to failure was 281 cells/µL (IQR 121, 457 cells/µL). More than half of participants [53%; 95% confidence interval (CI) 49–56%] stated that they had > 90% adherence and 75% (95% CI 72–77%) took their ART on time all or most of the time. Conversely, the vast majority (90%; 95% CI 86–92%) with a completed genotypic drug resistance test had any HIV drug resistance. This population had high health system use, reporting a median of 3 (IQR 2.6) health care visits and a median of 1 (IQR 1.1) hospitalization in the preceding 6 months. Conclusions: Patients failing first-line ART in sub-Saharan Africa generally report high rates of adherence to ART, have extremely high rates of HIV drug resistance and utilize significant health care resources. Health systems interventions to promptly detect and manage treatment failure will be a prerequisite to establishing control of the HIV epidemic. |
| Databáze: | OpenAIRE |
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