Revisiting Long-Term Adherence to Highly Active Antiretroviral Therapy in Senegal Using Latent Class Analysis

Bastard, Mathieu; Fall, M.; Lanièce, Isabelle; Taverne, Bernard; Desclaux, Alice; Écochard, René; Sow, Papa Salif; Delaporte, Eric; Etard, Jean‐François

doi:10.1097/qai.0b013e318211b43b

Cited by 36 publications

(26 citation statements)

References 39 publications

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“…In our study 6% of patient appointments were attended with a delay of one or more days. Although previous studies have suggested that adherence might decline with time on ART [13], in our analysis, both the proportion of appointments attended with delay and the interval between successive clinic visits remained almost constant over time since treatment initiation. The median treatment duration of study patients was 26 months and 75% of individuals had received therapy for less than 45 months.…”

Section: Discussioncontrasting

confidence: 73%

Timeliness of Clinic Attendance Is a Good Predictor of Virological Response and Resistance to Antiretroviral Drugs in HIV-Infected Patients

Bastard¹,

Pinoges²,

Balkan

et al. 2012

PLoS ONE

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BackgroundEnsuring long-term adherence to therapy is essential for the success of HIV treatment. As access to viral load monitoring and genotyping is poor in resource-limited settings, a simple tool to monitor adherence is needed. We assessed the relationship between an indicator based on timeliness of clinic attendance and virological response and HIV drug resistance.MethodsData from 7 virological cross-sectional studies were pooled. An adherence indicator was calculated as the number of appointments attended with delay divided by the number of months between antiretroviral treatment (ART) initiation and date of virological testing and multiplying this by 100. Delays of 1 or more to 5 or more days were considered in turn. Multivariate random-intercept logistic regression was fitted to examine the effect on outcomes, separately for adults and children.ResultsA total of 3580 adults and 253 children were included. Adults were followed for a median of 26.0 months (IQR 12.8-45.0) and attended a median of 24 visits (IQR 13–34). The 1-day delay adherence indicator was strongly associated with viral load suppression (OR 0.96, 95% CI 0.95–0.97 per unit increase), virological failure (OR 1.05, 95% CI 1.03–1.06) and HIV drug resistance (OR 1.03, 95% CI 1.01–1.05) after adjusting for initial age and CD4 count, previous ART experience, type of regimen and Tuberculosis diagnosis at start of therapy. Similar results were observed in children.ConclusionAn adherence indicator based on timeliness of clinic attendance predicts strongly both virological response and drug resistance, and could help to timely identify non-adherent patients in settings where viral load monitoring is not available.

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Section: Discussioncontrasting

confidence: 73%

Timeliness of Clinic Attendance Is a Good Predictor of Virological Response and Resistance to Antiretroviral Drugs in HIV-Infected Patients

Bastard¹,

Pinoges²,

Balkan

et al. 2012

PLoS ONE

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“…In a high risk urban population in sub-Saharan Africa 38% of patients were non-adherent to HAART at some point during their treatment [10]. Furthermore, adherence to HAART appears to decrease steadily over time but may vary by gender and HAART regimen [11]. In Rwanda, where HIV prevalence is 2.9% and approximately 70,047 HIV+ persons receive HAART, there has been limited study of both HAART adherence rates and factors associated non-adherence.…”

Section: Introductionmentioning

confidence: 99%

Adherence to Highly Active Antiretroviral Treatment in HIV-Infected Rwandan Women

Musiime¹,

Muhairwe²,

Rutagengwa

et al. 2011

PLoS ONE

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BackgroundScale-up of highly active antiretroviral treatment therapy (HAART) programs in Rwanda has been highly successful but data on adherence is limited. We examined HAART adherence in a large cohort of HIV+ Rwandan women.MethodsThe Rwanda Women's Interassociation Study Assessment (RWISA) was a prospective cohort study that assessed effectiveness and toxicity of ART. We analyzed patient data 12±3 months after HAART initiation to determine adherence rates in HIV+ women who had initiated HAART.ResultsOf the 710 HIV+ women at baseline, 490 (87.2%) initiated HAART. Of these, 6 (1.2%) died within 12 months, 15 others (3.0%) discontinued the study and 80 others (19.0%) remained in RWISA but did not have a post-HAART initiation visit that fell within the 12±3 month time points leaving 389 subjects for analysis. Of these 389, 15 women stopped their medications without being advised to do so by their doctors. Of the remaining 374 persons who reported current HAART use 354 completed the adherence assessment. All women, 354/354, reported 100% adherence to HAART at the post-HAART visit. The high self-reported level of adherence is supported by changes in laboratory measures that are influenced by HAART. The median (interquartile range) CD4 cell count measured within 6 months prior to HAART initiation was 185 (128, 253) compared to 264 (182, 380) cells/mm3 at the post-HAART visit. Similarly, the median (interquartile range) MCV within 6 months prior to HAART initiation was 88 (83, 93) fL compared to 104 (98, 110) fL at the 12±3 month visit.ConclusionSelf-reported adherence to antiretroviral treatment 12±3 months after initiating therapy was 100% in this cohort of HIV-infected Rwandan women. Future studies should explore country-specific factors that may be contributing to high levels of adherence to HAART in this population.

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“…Third, LCA was used as a data reduction technique by which to categorize individuals into their most likely class membership along the spectrum of the SUMIC Syndemic (non-observable latent variable, based on the latent conditions of active substance use, mental illness, and familial conflict non-negotiation; Bastard et al, 2011; Ahn et al, 2008; Collins & Lanza, 2010). Fourth, the syndemic classes were regressed on the three relevant correlates: sex, viral suppression (UVL), and acute care non-utilization (ACN).…”

Section: Methodsmentioning

confidence: 99%

“…However, assessment of Syndemic Theory in a sample of all African-American HIV-positive persons with a history of substance use has not been conducted to our knowledge. Also, unlike these studies, the present analyses utilized latent class analyses, which has been applied in several previous investigations of Syndemic Theory (Bastard et al, 2011; Ahn et al, 2008; Collins & Lanza, 2010). Therefore, the purpose of this study was to examine the presence and correlates of a potential latent syndemic in a cohort of African-American PLHIV.…”

Section: Introductionmentioning

confidence: 99%

Substance use, mental illness, and familial conflict non-negotiation among HIV-positive African-Americans: latent class regression and a new syndemic framework

et al. 2015

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Introduction We evaluated a synergistic epidemic (syndemic) of substance use, mental illness, and familial conflict non-negotiation among HIV-positive injection drug users (IDU). Method Baseline BEACON study data was utilized. Latent class analyses identified syndemic classes. These classes were regressed on sex, viral suppression, and acute care non-utilization. Females were hypothesized to have higher syndemic burden, and worse health outcomes than males. Results Nine percent of participants had high substance use/mental illness prevalence (Class 4); 23% had moderate levels of all factors (Class 3); 25% had high mental illness (Class 2); 43% had moderate substance use/mental illness (Class 1; N=331). Compared to Classes 1–3, Class 4 was mostly female (p<.05), less likely to achieve viral suppression, and more likely to utilize acute care (p<.05). Discussion Interventions should target African-American IDU females to improve their risk of negative medical outcomes. Findings support comprehensive syndemic approaches to HIV interventions, rather than singular treatment methods.

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Revisiting Long-Term Adherence to Highly Active Antiretroviral Therapy in Senegal Using Latent Class Analysis

Cited by 36 publications

References 39 publications

Timeliness of Clinic Attendance Is a Good Predictor of Virological Response and Resistance to Antiretroviral Drugs in HIV-Infected Patients

Timeliness of Clinic Attendance Is a Good Predictor of Virological Response and Resistance to Antiretroviral Drugs in HIV-Infected Patients

Adherence to Highly Active Antiretroviral Treatment in HIV-Infected Rwandan Women

Substance use, mental illness, and familial conflict non-negotiation among HIV-positive African-Americans: latent class regression and a new syndemic framework

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