| Titre : | Adherence to first-line antiretroviral therapy affects non-virologic outcomes among patients on treatment for more than 12 months in Lusaka, Zambia. (2009) |
| Auteurs : | Benjamin-H CHI ; Marc BULTERYS ; Ronald-A CANTRELL ; Jens-W LEVY ; Lloyd-B MULENGA ; MWANGO (Albert) : ZMB. Zambian Ministry of Health. Lusaka. ; Alwyn MWINGA ; Stewart REID ; Michael-S SAAG ; Jeffrey-Sa STRINGER ; TAMBATAMBA (Bushimbwa-C) : ZMB. Lusaka Urban District Health Management Team. Zambian Ministry of Health. Lusaka. ; ZULU (Isaac) : ZMB. School of Medicine. University of Zambia. Lusaka. ; School of Medicine and Public Health. University of Alabama. Birmingham. AL. USA |
| Type de document : | Article |
| Dans : | International journal of epidemiology (vol. 38, n° 3, 2009) |
| Pagination : | 746-756 |
| Langues: | Anglais |
| Mots-clés : | Sida ; Observance thérapeutique ; Médicament antirétroviral ; Traitement antirétroviral ; Médicament antiviral ; Pronostic ; Thérapeutique ; Evolution ; Homme ; Malade ; Zambie ; VIH ; Médicament ; Thérapeutique médicamenteuse ; Chimiothérapie ; Mortalité ; Epidémiologie ; Survie ; Virose ; Infection ; Afrique ; Rétrovirus ; Virus ; Immunopathologie |
| Résumé : | [BDSP. Notice produite par INIST-CNRS 9IR0xBFq. Diffusion soumise à autorisation]. Background. High-level adherence to antiretroviral therapy (ART) is associated with favourable patient outcomes. In resource-constrained settings, however, there are few validated measures. We examined the correlation between clinical outcomes and the medication possession ratio (MPR), a pharmacy-based measure of adherence. Methods. We analysed data from a large programmatic cohort across 18 primary care centres providing ART in Lusaka, Zambia. Patients were stratified into three categories based on MPR-calculated adherence over the first 12 months : optimal (>=95%), suboptimal (80-94%) and poor (<80%). Results. Overall, 27115 treatment-naïve adults initiated and continued ART for>=12 months : 17 060 (62.9%) demonstrated optimal adherence, 7682 (28.3%) had suboptimal adherence and 2373 (8.8%) had poor adherence. When compared with those with optimal adherence, post-12-month mortality risk was similar among patients with sub-optimal adherence [adjusted hazard ratio (AHR)=1.0 ; 95% CI : 0.9-1.2] but higher in patients with poor adherence (AHR=1.7 ; 95% CI : 1.4-2.2). Those<80% MPR also appeared to have an attenuated CD4 response at 18 months (185 cells/mul vs 217 cells/mul ; P<0.001), 24 months (213 cells/mul vs 246 cells/mul ; P<0.001), 30 months (226 cells/mul vs 261 cells/mul ; P<0.001) and 36 months (245 cells/mul vs 275 cells/mul ; P<0.01) when compared with those above this threshold. Conclusions. MPR was predictive of clinical outcomes and immunologic response in this large public sector antiretroviral treatment program. This marker may have a role in guiding programmatic monitoring and clinical care in resource-constrained settings. |
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