TY - JOUR
T1 - Early warning indicators for first-line virologic failure independent of adherence measures in a South African Urban clinic
AU - Marconi, Vincent C.
AU - Wu, Baohua
AU - Hampton, Jane
AU - Ordóñez, Claudia E.
AU - Johnson, Brent A.
AU - Singh, Dinesh
AU - John, Sally
AU - Gordon, Michelle
AU - Hare, Anna
AU - Murphy, Richard
AU - Nachega, Jean
AU - Kuritzkes, Daniel R.
AU - Del Rio, Carlos
AU - Sunpath, Henry
PY - 2013/12/1
Y1 - 2013/12/1
N2 - We sought to develop individual-level Early Warning Indicators (EWI) of virologic failure (VF) for clinicians to use during routine care complementing WHO population-level EWI. A case-control study was conducted at a Durban clinic. Patients after≥5 months of first-line antiretroviral therapy (ART) were defined as cases if they had VF [HIV-1 viral load (VL)>1000 copies/mL] and controls (2:1) if they had VL≤1000 copies/mL. Pharmacy refills and pill counts were used as adherence measures. Participants responded to a questionnaire including validated psychosocial and symptom scales. Data were also collected from the medical record. Multivariable logistic regression models of VF included factors associated with VF (p<0.05) in univariable analyses. We enrolled 158 cases and 300 controls. In the final multivariable model, male gender, not having an active religious faith, practicing unsafe sex, having a family member with HIV, not being pleased with the clinic experience, symptoms of depression, fatigue, or rash, low CD4 counts, family recommending HIV care, and using a TV/radio as ART reminders (compared to mobile phones) were associated with VF independent of adherence measures. In this setting, we identified several key individual-level EWI associated with VF including novel psychosocial factors independent of adherence measures.
AB - We sought to develop individual-level Early Warning Indicators (EWI) of virologic failure (VF) for clinicians to use during routine care complementing WHO population-level EWI. A case-control study was conducted at a Durban clinic. Patients after≥5 months of first-line antiretroviral therapy (ART) were defined as cases if they had VF [HIV-1 viral load (VL)>1000 copies/mL] and controls (2:1) if they had VL≤1000 copies/mL. Pharmacy refills and pill counts were used as adherence measures. Participants responded to a questionnaire including validated psychosocial and symptom scales. Data were also collected from the medical record. Multivariable logistic regression models of VF included factors associated with VF (p<0.05) in univariable analyses. We enrolled 158 cases and 300 controls. In the final multivariable model, male gender, not having an active religious faith, practicing unsafe sex, having a family member with HIV, not being pleased with the clinic experience, symptoms of depression, fatigue, or rash, low CD4 counts, family recommending HIV care, and using a TV/radio as ART reminders (compared to mobile phones) were associated with VF independent of adherence measures. In this setting, we identified several key individual-level EWI associated with VF including novel psychosocial factors independent of adherence measures.
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U2 - 10.1089/apc.2013.0263
DO - 10.1089/apc.2013.0263
M3 - Article
C2 - 24320011
AN - SCOPUS:84890344125
SN - 1087-2914
VL - 27
SP - 657
EP - 668
JO - AIDS patient care and STDs
JF - AIDS patient care and STDs
IS - 12
ER -