Antiretroviral Treatment Interruptions Induced by the Kenyan Postelection Crisis Are Associated With Virological Failure

Mann, Marita; Diero, Lameck; Kemboi, Emmanuel; Mambo, Fidelis; Rono, Mary; Injera, Wilfred E.; DeLong, Allison; Schreier, Leeann; Kaloustian, Kara Wools; Sidle, John E.; Buziba, Nathan; Kantor, Rami

doi:10.1097/qai.0b013e31829ec485

Cited by 22 publications

(26 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The high overall (89%) and dual-class (83%) resistance is consistent with other reports from AMPATH [23,26] and other RLS upon any (not solely TDF-based) first-line ART [37]. The few studies that evaluated resistance in TDF-based first-line regimens in RLS, mostly in subtypes C, G and CRF02_AG from Southern Africa and Nigeria, do not report overall resistance but estimate NRTI- (94 to 100%) and NNRTI-associated resistance (57 to 97%) to be high [9–11,13,16].…”

Section: Discussionsupporting

confidence: 91%

See 1 more Smart Citation

Treatment failure and drug resistance in HIV‐positive patients on tenofovir‐based first‐line antiretroviral therapy in western Kenya

Brooks

Diero

DeLong

et al. 2016

Journal of the International AIDS Society

Self Cite

View full text Add to dashboard Cite

IntroductionTenofovir-based first-line antiretroviral therapy (ART) is recommended globally. To evaluate the impact of its incorporation into the World Health Organization (WHO) guidelines, we examined treatment failure and drug resistance among a cohort of patients on tenofovir-based first-line ART at the Academic Model Providing Access to Healthcare, a large HIV treatment programme in western Kenya.MethodsWe determined viral load (VL), drug resistance and their correlates in patients on ≥six months of tenofovir-based first-line ART. Based on enrolled patients’ characteristics, we described these measures in those with (prior ART group) and without (tenofovir-only group) prior non-tenofovir-based first-line ART using Wilcoxon rank sum and Fisher's exact tests.ResultsAmong 333 participants (55% female; median age 41 years; median CD4 336 cells/µL), detectable (>40 copies/mL) VL was found in 18%, and VL>1000 copies/mL (WHO threshold) in 10%. Virologic failure at both thresholds was significantly higher in 217 participants in the tenofovir-only group compared with 116 in the prior ART group using both cut-offs (24% vs. 7% with VL>40 copies/mL; 15% vs. 1% with VL>1000 copies/mL). Failure in the tenofovir-only group was associated with lower CD4 values and advanced WHO stage. In 35 available genotypes from 51 participants in the tenofovir-only group with VL>40 copies/mL (69% subtype A), any resistance was found in 89% and dual-class resistance in 83%. Tenofovir signature mutation K65R occurred in 71% (17/24) of the patients infected with subtype A. Patients with K65R had significantly lower CD4 values, higher WHO stage and more resistance mutations.ConclusionsIn this Kenyan cohort, tenofovir-based first-line ART resulted in good (90%) virologic suppression including high suppression (99%) after switch from non-tenofovir-based ART. Lower virologic suppression (85%) and high observed resistance levels (89%) in the tenofovir-only group impact future treatment options, support recommendations for widespread VL monitoring in such resource limited settings to identify early treatment failure and suggest consideration of individualized resistance testing to design effective subsequent regimens.

show abstract

Section: Discussionsupporting

confidence: 91%

“…Few studies on acquired resistance, prior to TDF incorporation in first-line regimens, report first-line resistance in 13 to 94% [23–26], with low (13%) K65R levels [25]. Transmission of this mutation in Kenya is rare [27].…”

Section: Introductionmentioning

confidence: 99%

Treatment failure and drug resistance in HIV‐positive patients on tenofovir‐based first‐line antiretroviral therapy in western Kenya

Brooks

Diero

DeLong

et al. 2016

Journal of the International AIDS Society

Self Cite

View full text Add to dashboard Cite

show abstract

“…There is evidence, albeit limited, that HIV patients receiving ART exposed to ARV stock shortages or stockouts (vs. those unexposed) in LMICs have an increased risk of viral load failure and attrition [3][4][5][6]. Our results, which show no impact of the shortage on loss to followup and viral load status, may be related to the fact that there was a stock shortage of tenofovir a not a complete stock-out.…”

Section: Discussionmentioning

confidence: 51%

Tenofovir stock shortages have limited impact on clinic‐ and patient‐level HIV treatment outcomes in public sector clinics in South Africa

Brennan

Bor

Davies

et al. 2016

Tropical Med Int Health

View full text Add to dashboard Cite

show abstract

“…ART coverage in Kenya increased from 64% in 2008 to 80% in 2013 (NACC, 2014). Despite this achievement, poor adherence and high loss to follow-up (LTFU) rates along the cascade of HIV care (Hassan et al, 2012; Karcher, Omondi, Odera, Kunz, & Harms, 2007; Mann et al, 2013; Mûnene & Ekman, 2015; Ochieng-Ooko et al, 2010) reduce the effectiveness of these efforts. These challenges have been attributed to various individual, social, and structural factors (Fox & Rosen, 2010; Merten et al, 2010; Ochieng-Ooko et al, 2010; Posse, Meheus, Van Asten, Van Der Ven, & Baltussen, 2008; Reda & Biadgilign, 2012; Vreeman et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

The Perspective of HIV Providers in Western Kenya on Provider-Patient Relationships

Wachira

Genberg

Kafu

et al. 2018

Journal of Health Communication

View full text Add to dashboard Cite

Enhancing effective adherence dialogue with HIV patients in an environment that promotes good provider-patient relationships, is key to optimizing the benefits of antiretroviral therapy (ART). The study examines the perspectives of HIV providers in western Kenya on provider-patient relationships. Sixty healthcare providers were sampled using convenience sampling methods from three Academic Model for Providing Access to Healthcare (AMPATH) sites (one urban and two rural). In-depth interviews conducted in either Swahili or English were audio recorded, transcribed, and translated into English. Content analysis was performed after thematic coding. Providers perceived that they had good relationships with most patients, and tended to identify negative patient attributes as the source of poor provider-patient relationships. Providers preferred patients who adhered to treatment guidelines. They did not like patients who challenged their authority, and did not see it as their responsibility to find more effective ways of interacting with patients who they found difficult. Structural barriers to collaborative physician-patient relationships included noncontinuity of relationships, lack of specific appointment times, high provider-patient ratio, and management of provider fatigue and job dissatisfaction. There is need for HIV care programs to identify culturally appropriate interventions to enhance better provider-patient relationship.

show abstract

Antiretroviral Treatment Interruptions Induced by the Kenyan Postelection Crisis Are Associated With Virological Failure

Cited by 22 publications

References 24 publications

Treatment failure and drug resistance in HIV‐positive patients on tenofovir‐based first‐line antiretroviral therapy in western Kenya

Treatment failure and drug resistance in HIV‐positive patients on tenofovir‐based first‐line antiretroviral therapy in western Kenya

Tenofovir stock shortages have limited impact on clinic‐ and patient‐level HIV treatment outcomes in public sector clinics in South Africa

The Perspective of HIV Providers in Western Kenya on Provider-Patient Relationships

Contact Info

Product

Resources

About