Transitioning to Second-line Antiretroviral Therapy Among Adolescents in Copperbelt Province, Zambia

Stalter, Randy M; Katayamoyo, Patrick; Packer, Catherine; Banda, Harry; Chen, Pai Lien; Mwansa, Jonathan K.; McCarraher, Donna R.; Denison, Julie A.

doi:10.1097/inf.0000000000001547

Cited by 5 publications

(3 citation statements)

References 40 publications

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“…On a contrary to the current study, another Zambian study found that there was suboptimal adherence to cART mainly due to increase in age [18]. This could have been that as adolescents increase in age, they are expected to take up more gender roles and responsibilities in society.…”

Section: Adherence To Cartcontrasting

confidence: 99%

Factors Influencing Adherence to Antiretroviral Therapy among HIV Positive Adolescents at Adult Infectious Diseases Center in Lusaka, Zambia

Namoomba¹,

Makukula²,

Masumo³

2019

OJN

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Background: Non-adherence to combination antiretroviral therapy leads to drug resistance, treatment failure and increased morbidity and mortality among HIV positive adolescents. The aim of this study was to assess factors influencing adherence to combination antiretroviral therapy among HIV positive adolescents at Adult Infectious Disease Center in Lusaka, Zambia. Methodology: A descriptive quantitative cross sectional study was conducted on 173 adolescent respondents on antiretroviral therapy who were selected using a systematic random sampling method. Data was collected using the questionnaires with the adopted Morisky drug adherence scale and analyzed using Statistical Package for the Social Sciences software, version 20. Chi square, fishers' exact statistical tests and the binary logistic regression model were used to determine true predictors and to adjust confounders of adherence. The cut off point for statistical significance was set at 5%. Results: This study established that 76 (43.9%) of the respondents were non-adherent to their antiretroviral therapy. Knowledge of HIV and disease progression was reported to be low but had no statistical impact on antiretroviral therapy adherence. Stigmatization was high (99 (57.2%)) but did not significantly influence adherence to combination antiretroviral therapy on the study participants. Factors which were found to be statistically significant to adherence to therapy when a binary logistic regression was performed were experiencing side effects to therapy (p-value 0.047, odds ratio = 0.412); understanding reason for taking combination antiretroviral therapy (p-value 0.006, odds ratio = 5.978) and being reminded to take drugs (p-value 0.006, odds ratio = 0.505). Conclusion: The study found that there was high level of non-adherence to combination antiretroviral therapy which could subsequently lead to

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Section: Adherence To Cartcontrasting

confidence: 99%

Factors Influencing Adherence to Antiretroviral Therapy among HIV Positive Adolescents at Adult Infectious Diseases Center in Lusaka, Zambia

Namoomba¹,

Makukula²,

Masumo³

2019

OJN

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“…Sharing the success story from South Africa would help in promoting VS in SSA [23,24]. Of relevance, VS is consistent with timely switch of paediatric ART [25][26][27][28], taking into consideration orphanhood and patient age for adequate monitoring and interpretation of PVL [29,30]. While supporting the use of 2 consecutive PVLs to confirm VF, further VL repeats should be discouraged for children known to be adherent, so as to prevent accumulating resistant patterns [15,31,32].…”

Section: Discussionmentioning

confidence: 99%

Determinants of switch to paediatric second‐line antiretroviral therapy after first‐line failure in Cameroon

Njom-Nlend

Efouba

Sandie

et al. 2021

Tropical Med Int Health

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Objective With scale‐up of antiretroviral therapy (ART) children, treatment failure and switch to subsequent ART regimens are common. Our objectives were to evaluate switching practices and identify factors associated among children and adolescents failing their first‐line ART. Methods A facility‐based survey study was conducted in a cohort of children living with HIV experiencing virological failure (VF) at the Essos Hospital Centre of Yaounde, Cameroon. Data were collected using a standard questionnaire, and key variables were as follows: (a) VF defined as viral load (VL) > 1000 copies/ml, (b) rate of switch to second‐line and (c) reason(s) for switching ART. Odds ratio (OR) with 95% confidence interval (CI) was used to assess the association between study variables, and P < 0.05 was considered statistically significant. Results A total of 106 children experiencing VF were enrolled: median age was 8 [interquartile range (IQR): 3–15] years; 60.38% were boys and 39.62% were orphans of one/both parents. A proportion of 69% were at the WHO clinical stage III/IV, and 13.21% were experiencing immunological failure (CD4 < 200 cells/mm3). The median duration on first‐line ART was 36 [IQR: 7–157] months prior to detecting VF, and the rate of switch to second‐line ART was 70.75% (75/106). Delay in switching ART after a confirmed VF was 11 [IQR: 7–16] months. After switch to second‐line ART, the median time to achieve undetectable VL (<40 copies/ml) was 14 [IQR: 9–21] months. Multivariate analysis revealed that only children with viral rebound (aOR = 0.09; 95% CI = 0.03–0.24) were less likely to be switched. Of note, being orphaned (aOR = 0.35, CI = 0.11–1.11), biological sex (aOR = 1.77, CI = 0.60–5.29) and immune status (aOR = 0.19, CI = 0.03–1.31, 0.09) had no significant effect on switching to second‐line ART. Conclusion In this paediatric population experiencing VF after about 3–4 years from ART initiation, the majority are switched to second‐line ART after a delay of almost one year. Delayed switch to second‐line was driven essentially by viral rebound, underscoring the need for close viral monitoring.

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“…Additionally, the patients’ perspectives seem to be given little consideration in the adherence intervention development and implementation. It is therefore important to assess effectiveness of existing strategies from the perspectives of PLHIV taking ART in order to recommend and develop relevant and acceptable strategies to patients [ 44 , 45 ]. This is evidenced in a study conducted in Malawi which highlighted how critical it is for health programmers to prioritize adherence view points from patients as part of strengthening the clinical monitoring strategy used [ 46 ].…”

Section: Introductionmentioning

confidence: 99%

Study protocol: Strengthening understanding of effective adherence strategies for first-line and second-line antiretroviral therapy (ART) in selected rural and urban communities in South Africa

et al. 2021

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Multiple factors make adherence to antiretroviral therapy (ART) a complex process. This study aims to describe the barriers and facilitators to adherence for patients receiving first-line and second-line ART, identify different adherence strategies utilized and make recommendations for an improved adherence strategy. This mixed method parallel convergent study will be conducted in seven high volume public health facilities in Gauteng and one in Limpopo province in South Africa. The study consists of four phases; a retrospective secondary data analysis of a large cohort of patients on ART (using TIER.Net, an ART patient and data management system for recording and monitoring patients on ART and tuberculosis (TB)) from seven Johannesburg inner-city public health facilities (Gauteng province); a secondary data analysis of the Intensified Treatment Monitoring Accumulation (ITREMA) trial (a randomized control trial which ran from June 2015 to January 2019) conducted at the Ndlovu Medical Center (Limpopo province); in-depth interviews with people living with Human Immunodeficiency Virus (PLHIV) who are taking ART (in both urban and rural settings); and a systematic review of the impact of treatment adherence interventions for chronic conditions in sub-Saharan Africa. Data will be collected on demographics, socio-economic status, treatment support, retention in care status, disclosure, stigma, clinical markers (CD4 count and viral load (VL)), self-reported adherence information, intrapersonal, and interpersonal factors, community networks, and policy level factors. The systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting and Population, Interventions, Comparisons and Outcomes (PICO) criteria. Analyses will involve tests of association (Chi-square and t-test), thematic analysis (deductive and inductive approaches) and network meta-analysis. Using an integrated multilevel socio-ecological framework this study will describe the factors associated with adherence for PLHIV who are taking first-line or second-line ART. Implementing evidence-based adherence approaches, when taken up, will improve patient’s overall health outcomes. Our study results will provide guidance regarding context-specific intervention strategies to improve ART adherence.

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Transitioning to Second-line Antiretroviral Therapy Among Adolescents in Copperbelt Province, Zambia

Cited by 5 publications

References 40 publications

Factors Influencing Adherence to Antiretroviral Therapy among HIV Positive Adolescents at Adult Infectious Diseases Center in Lusaka, Zambia

Factors Influencing Adherence to Antiretroviral Therapy among HIV Positive Adolescents at Adult Infectious Diseases Center in Lusaka, Zambia

Determinants of switch to paediatric second‐line antiretroviral therapy after first‐line failure in Cameroon

Study protocol: Strengthening understanding of effective adherence strategies for first-line and second-line antiretroviral therapy (ART) in selected rural and urban communities in South Africa

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