High Medication Possession Ratios Associated with Greater Risk of Virologic Failure Among Youth Compared to Adults in a Nigerian Cohort

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  Ahonkhai, Aimalohi A. ; Banigbe, Bolanle ; Adeola, Juliet ; Bassett, Ingrid V. ; Idigbe, Ifeoma ; Okonkwo, Prosper ; Freedberg, Kenneth A. ; Regan, Susan ; Losina, Elena
• Description:
  Background
  
  Medication possession ratio (MPR) is widely used as a measure of adherence to antiretroviral therapy (ART). Many adolescents and young adults (AYA) experience ART adherence challenges. Our objective was to determine whether the relationship between MPR and virologic failure (VF) is consistent between AYA and older adults in Nigeria.
  
  Methods
  
  We conducted a retrospective study of AYA (15–25 years) and adults (>25 years) who initiated ART between January 2009 and December 2012 at 10 university-affiliated HIV clinics in Nigeria. We used multivariate generalized linear models to assess the relationship between age, MPR (ART doses dispensed)/(days since ART initiation), and risk of VF (HIV RNA >1,000 copies/mL) in the first year on ART.
  
  Results
  
  The cohort included 1,508 AYA and 11,376 older adults. VF was more common in AYA than older adults (30% vs. 24% p<0.01). Overall, 74% of patients had optimal, 16% suboptimal, and 9% poor adherence (MPR >94%, 80–94%, and <80%). AYA attended fewer pharmacy-only visits than older adults (5 vs. 6, p<0.001). Higher MPR was associated with decreased rate of VF (80–94%, aRR 0.57; >94% aRR 0.43, p<0.001 vs. MPR <80%). Among those with optimal adherence by MPR, 26% of AYA had VF, a risk that was 20% higher than for older adults with optimal adherence (p<0.001).
  
  Conclusions
  
  In this Nigerian cohort, MPRs were high overall, and there was a strong association between low MPR and risk of VF. Nonetheless, 26% of AYA with high MPRs still had VF. Understanding the discrepancy between MPR and viral suppression in AYA is an important priority. 
  
  
• Subjects:
  Adherence Adolescent Adult Anti-HIV Agents Article Female HIV Infections Humans Male Medication Possession Ratio MPR Nigeria Retrospective Studies Viral Load Virologic Failure Young Adult Youth

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• Source:
  J Acquir Immune Defic Syndr. 78(3):322-328
• Pubmed ID:
  29533304
• Pubmed Central ID:
  PMC5997516
• Document Type:
  Journal Article
• Funding:
  R01 MH108427/MH/NIMH NIH HHSUnited States/ ; U2G GH000924/GH/CGH CDC HHSUnited States/ ; K23 AI106406/AI/NIAID NIH HHSUnited States/ ; R01 AI058736/AI/NIAID NIH HHSUnited States/ ; R37 AI058736/AI/NIAID NIH HHSUnited States/
• Place as Subject:
  Nigeria
• Volume:
  78
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:8d79865b3e9bcc4a6dc90a3e159227c43b1d43d4b6d9dbcf4d3b848fb98420cd
• Download URL:
  https://stacks.cdc.gov/view/cdc/55857/cdc_55857_DS1.pdf
• File Type:
  [PDF - 202.64 KB ]