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Who's slipping through the cracks? A comprehensive individual, clinical and health system characterization of people with virological failure on first-line HIV treatment in Uganda and South Africa.
Reynolds, Zahra; McCluskey, Suzanne M; Moosa, Mahomed Yunus S; Gilbert, Rebecca F; Pillay, Selvan; Aturinda, Isaac; Ard, Kevin L; Muyindike, Winnie; Musinguzi, Nicholas; Masette, Godfrey; Moodley, Pravi; Brijkumar, Jaysingh; Rautenberg, Tamlyn; George, Gavin; Johnson, Brent A; Gandhi, Rajesh T; Sunpath, Henry; Marconi, Vincent C; Bwana, Mwebesa Bosco; Siedner, Mark J.
Afiliación
  • Reynolds Z; Massachusetts General Hospital, Boston, MA, USA.
  • McCluskey SM; Massachusetts General Hospital, Boston, MA, USA.
  • Moosa MYS; Harvard Medical School, Boston, MA, USA.
  • Gilbert RF; University of KwaZulu-Natal, Durban, South Africa.
  • Pillay S; Massachusetts General Hospital, Boston, MA, USA.
  • Aturinda I; University of KwaZulu-Natal, Durban, South Africa.
  • Ard KL; Mbarara University of Science and Technology, Mbarara, Uganda.
  • Muyindike W; Massachusetts General Hospital, Boston, MA, USA.
  • Musinguzi N; Harvard Medical School, Boston, MA, USA.
  • Masette G; Mbarara University of Science and Technology, Mbarara, Uganda.
  • Moodley P; Mbarara University of Science and Technology, Mbarara, Uganda.
  • Brijkumar J; Mbarara University of Science and Technology, Mbarara, Uganda.
  • Rautenberg T; University of KwaZulu-Natal, Durban, South Africa.
  • George G; National Health Laboratory Service, KwaZulu-Natal, Durban, South Africa.
  • Johnson BA; University of KwaZulu-Natal, Durban, South Africa.
  • Gandhi RT; Griffith University, Brisbane, QLD, Australia.
  • Sunpath H; University of KwaZulu-Natal, Durban, South Africa.
  • Marconi VC; Department of Biostatistics and Computation Biology, University of Rochester, Rochester, NY, USA.
  • Bwana MB; Massachusetts General Hospital, Boston, MA, USA.
  • Siedner MJ; Harvard Medical School, Boston, MA, USA.
HIV Med ; 23(5): 474-484, 2022 05.
Article en En | MEDLINE | ID: mdl-34755438
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.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Infecciones por VIH / Fármacos Anti-VIH Tipo de estudio: Prognostic_studies Límite: Adult / Female / Humans País/Región como asunto: Africa Idioma: En Revista: HIV Med Asunto de la revista: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Infecciones por VIH / Fármacos Anti-VIH Tipo de estudio: Prognostic_studies Límite: Adult / Female / Humans País/Región como asunto: Africa Idioma: En Revista: HIV Med Asunto de la revista: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos