Adherence to antiretroviral therapy assessed by drug level monitoring and self-report in cameroon
Authors
Kouanfack, CharlesLaurent, Christian
Peytavin, Gilles
Ciaffi, Laura
Ngolle, Maguy
Nkene, Yvette Mawamba
Essomba, Claudine
Calmy, Alexandra
Mpoudi-Ngolé, Eitel
Delaporte, Eric
Koulla-Shiro, Sinata
Affiliation
Central Hospital, Yaoundé, Cameroon; Institut de recherche pour le developpement, University of Montpellier, Montpellier, France; Laboratoire de Toxicologie et de Dosage de Medicaments, Centre Hospitalier Universitaire Bichat Claude Bernard, Paris, France; Medecins Sans Frontieres, Geneva, Switzerland; Projet PRESICA (Prevention du Sida au Cameroun), Military Hospital, Yaounde, CameroonIssue Date
2008-06-01
Metadata
Show full item recordAbstract
OBJECTIVES: To compare adherence to antiretroviral therapy using drug level monitoring and self-report and to explore the relation between these 2 methods and viral load measurements. METHODS: Sixty patients received a fixed-dose combination of nevirapine, stavudine, and lamivudine in a clinical study in Cameroon. Adherence was assessed every 6 months until month 36 by nevirapine minimal plasma concentration and self-report. Plasma HIV-1 viral load was determined at the same time. Analyses included 159 complete observations. RESULTS: The proportion of patients labeled as "adherent" was significantly lower using nevirapine monitoring (88.7%, 95% confidence interval [CI]: 82.7 to 93.2) than self-report (97.5%, CI: 93.7 to 99.3; P = 0.002). Virologic failure was associated with the nevirapine concentration (adjusted odds ratio [aOR] = 4.43; P = 0.018) but not with the self-reported adherence (aOR = 0.84; P = 0.9). As compared with the virologic outcome, the sensitivity of nevirapine level monitoring for predicting inadequate adherence was 20.5%, the specificity was 91.7%, the positive predictive value was 44.4%, and the negative predictive value was 78.0%. For self-report, the respective values were 2.6%, 97.5%, 25.0%, and 75.5%. CONCLUSIONS: Drug level monitoring provided a more reliable estimate of adherence than self-report. This method could be used in research settings. Operational research is required to define how to improve the accuracy of the self-report method because it is the most feasible method in clinical practice.PubMed ID
18520681Additional Links
http://journals.lww.com/jaids/pages/articleviewer.aspx?year=2008&issue=06010&article=00015&type=abstractType
ArticleLanguage
enISSN
1525-4135ae974a485f413a2113503eed53cd6c53
10.1097/QAI.0b013e3181743955