Early warning indicators for first-line virologic failure independent of adherence measures in a South African urban clinic.
Authors
Marconi, Vincent CWu, Baohua
Hampton, Jane
Ordóñez, Claudia E
Johnson, Brent A
Singh, Dinesh
John, Sally
Gordon, Michelle
Hare, Anna
Murphy, Richard
Nachega, Jean
Kuritzkes, Daniel R
Del Rio, Carlos
Sunpath, Henry
South Africa Resistance Cohort Study Team Group Authors
Issue Date
2013-12
Metadata
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AIDS Patient Care and STDsAbstract
Abstract 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.PubMed ID
24320011Language
enISSN
1557-7449ae974a485f413a2113503eed53cd6c53
10.1089/apc.2013.0263
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