Second-Line Antiretroviral Therapy in a Workplace and Community-Based Treatment Programme in South Africa: Determinants of Virological Outcome

Details

• Alternative Title:
  PLoS One
• Personal Author:
  Johnston, Victoria ; Fielding, Katherine ; Charalambous, Salome ; Mampho, Mildred ; Churchyard, Gavin ; Phillips, Andrew ; Grant, Alison D.
• Description:
  As antiretroviral treatment (ART) programmes in resource-limited settings mature, more patients are experiencing virological failure. Without resistance testing, deciding who should switch to second-line ART can be difficult. The consequences for second-line outcomes are unclear. In a workplace- and community-based multi-site programme, with 6-monthly virological monitoring, we describe outcomes and predictors of viral suppression on second-line, protease inhibitor-based ART.|We used prospectively collected clinic data from patients commencing first-line ART between 1/1/03 and 31/12/08 to construct a study cohort of patients switched to second-line ART in the presence of a viral load (VL) ≥ 400 copies/ml. Predictors of VL<400 copies/ml within 15 months of switch were assessed using modified Poisson regression to estimate risk ratios.|205 workplace patients (91.7% male; median age 43 yrs) and 212 community patients (38.7% male; median age 36 yrs) switched regimens. At switch compared to community patients, workplace patients had a longer duration of viraemia, higher VL, lower CD4 count, and higher reported non-adherence on first-line ART. Non-adherence was the reported reason for switching in a higher proportion of workplace patients. Following switch, 48.3% (workplace) and 72.0% (community) achieved VL<400, with non-adherence (17.9% vs. 1.4%) and virological rebound (35.6% vs. 13.2% with available measures) reported more commonly in the workplace programme. In adjusted analysis of the workplace programme, lower switch VL and younger age were associated with VL<400. In the community programme, shorter duration of viraemia, higher CD4 count and transfers into programme on ART were associated with VL<400.|High levels of viral suppression on second-line ART can be, but are not always, achieved in multi-site treatment programmes with both individual- and programme-level factors influencing outcomes. Strategies to support both healthcare workers and patients during this switch period need to be evaluated; sub-optimal adherence, particularly in the workplace programme must be addressed.
• Subjects:
  Adult Anti-HIV Agents Female HIV Humans Male Middle Aged Patient Compliance Residence Characteristics Treatment Outcome Viral Load Withholding Treatment Workplace

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• Source:
  PLoS One. 2012; 7(5).
• DOI:
  http://dx.doi.org/10.1371/journal.pone.0036997
• Pubmed ID:
  22666338
• Pubmed Central ID:
  PMC3362581
• Document Type:
  Journal Article
• Funding:
  G0700837/Medical Research Council/United Kingdom ; U2G PS000811/PS/NCHHSTP CDC HHS/United States ; 087261/Z/08/Z/Wellcome Trust/United Kingdom ; 5U2GPS000811/PEPFAR/United States
• Name as Subject:
  United States. President's Emergency Plan For AIDS Relief (PEPFAR)
• Place as Subject:
  South Africa
• Volume:
  7
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:22c942793beb8a0be0de1d700e7eaba4fb00b5a0d5ca4e5e12d3263d44fe8e88d838154c41423df135a1081348567291ef02956514728c72d4d0d9975e840ae3
• Download URL:
  https://stacks.cdc.gov/view/cdc/43628/cdc_43628_DS1.pdf
• File Type:
  [PDF - 209.52 KB ]