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

Abstract

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.

PEERNaija: A Gamified mHealth Behavioral Intervention to Improve Adherence to Antiretroviral Treatment Among Adolescents and Young Adults in Nigeria

“…Integrating these quantitative and qualitative research experiences in Nigeria and the US with reviews of the literature led us to focus on an intervention package that would help to overcome the issue of forgetting to take medication (9). The intervention package would also provide critical social support (5,(12)(13)(14)(15), while being very mindful not to magnify other barriers such as stigma (12,13), and time/transportation/resources to travel to the clinic (16,17).…”

“…Dr. Ahonkhai’s preliminary quantitative data demonstrated that 40% of Nigerian AYA-HIV who remained in care 1 year after starting ART had virologic failure (HIV RNA > 1,000 copies/mL) ( 4 ). Further, in a multi-site study of adherence measured by medication possession ratio (MPR), which is the proportion of prescribed doses of ART picked up from the pharmacy, AYA-HIV with MPR > 94% had a marked reduction in the risk of virologic failure in the first year on ART compared to those with MPR < 80% (aRR 0.43, p < 0.001) ( 15 ). Nonetheless, 26% of AYA-HIV with optimal adherence by MPR (>94%) still had virologic failure, highlighting discordance between ART pick-up from the pharmacy and ART taking behavior among some youth ( 15 ).…”

“…Further, in a multi-site study of adherence measured by medication possession ratio (MPR), which is the proportion of prescribed doses of ART picked up from the pharmacy, AYA-HIV with MPR > 94% had a marked reduction in the risk of virologic failure in the first year on ART compared to those with MPR < 80% (aRR 0.43, p < 0.001) ( 15 ). Nonetheless, 26% of AYA-HIV with optimal adherence by MPR (>94%) still had virologic failure, highlighting discordance between ART pick-up from the pharmacy and ART taking behavior among some youth ( 15 ). These data underscored both the high prevalence of virologic failure and the need for adherence support measures to help AYA-HIV to take their medicines.…”

“…Social connectivity is another gamification approach that may be of particular importance for AYA-HIV. Lack of social support is a common obstacle to adherence, and fear of stigma and unwanted disclosure can further promote social exclusion and isolation from other potential sources of support (5,(12)(13)(14)(15). PEERNaija provides a virtual, anonymous, peer-based social support group that may address an important need for social support, along with social accountability.…”

“…Stigma may often push AYA-HIV into isolation with their disease and ultimately impede adherence to HIV care and treatment (12,13). Social support is a critical environmental factor that can help to combat stigma and isolation for AYA-HIV (5,(12)(13)(14)(15). Structural barriers to medication adherence identified by AYA-HIV include indirect costs of care (cost of travel to the clinic or pharmacy, lost wages incurred on clinical or drug pick-up days for the patient, and caregiver, etc.)…”