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    Jan 16, 2021
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    Adherence to antiretroviral therapy assessed by drug level monitoring and self-report in cameroon

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    Authors
    Kouanfack, Charles
    Laurent, Christian
    Peytavin, Gilles
    Ciaffi, Laura
    Ngolle, Maguy
    Nkene, Yvette Mawamba
    Essomba, Claudine
    Calmy, Alexandra
    Mpoudi-Ngolé, Eitel
    Delaporte, Eric
    Koulla-Shiro, Sinata
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    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, Cameroon
    Issue Date
    2008-06-01
    
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    Journal
    Journal of Acquired Immune Deficiency Syndromes (1999)
    Abstract
    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.
    URI
    http://hdl.handle.net/10144/116998
    DOI
    10.1097/QAI.0b013e3181743955
    PubMed ID
    18520681
    Additional Links
    http://journals.lww.com/jaids/pages/articleviewer.aspx?year=2008&issue=06010&article=00015&type=abstract
    Type
    Article
    Language
    en
    ISSN
    1525-4135
    ae974a485f413a2113503eed53cd6c53
    10.1097/QAI.0b013e3181743955
    Scopus Count
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    HIV/AIDS

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