Premium
Seguimiento de 84 meses de la adherencia a la Terapia Antirretroviral Altamente Activa en una cohorte de pacientes senegaleses adultos
Author(s) -
Etard JeanFrançois,
Lanièce Isabelle,
Fall Mame Basty Koita,
Cilote Vannina,
Blazejewski Laure,
Diop Karim,
Desclaux Alice,
Ecochard René,
Ndoye Ibra,
Delaporte Eric
Publication year - 2007
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2007.01910.x
Subject(s) - medicine , interquartile range , regimen , pill , context (archaeology) , cohort , human immunodeficiency virus (hiv) , medication adherence , logistic regression , family medicine , paleontology , pharmacology , biology
Summary Objectives To assess long‐term adherence of the first HIV‐1 patients receiving highly active antiretroviral therapy (HAART) in Senegal, and to identify the main determinants of adherence. Methods The first 180 patients enrolled in the Senegalese HAART initiative between August 1998 and April 2001 followed up for at least 30 days were eligible. Adherence was assessed monthly at each drug dispensation between November 1999 and November 2006 by a pharmacist using a pill count completed by a questionnaire. Adherence was expressed as the proportion of tablets taken to prescribed tablets. An adherence of 95% was considered to be good. A random‐intercept logit model was fitted to identify the main determinants of adherence. Results Adherence data were available for 158 of 167 eligible patients. Twenty‐nine patients died during the study period and 10 were lost to follow‐up. Median treatment duration was 78 months, accruing to 6657 person‐months of observation. Overall, mean adherence reached 91% [median: 100%, interquartile range (IQR) 96‐100%] and adherence exceeded 95% in 78% [95% CI 77‐79%] of observations. After 4 years of treatment mean adherence stabilized around 90% and adherence 95% stabilized around 70%. Treatment duration and protease inhibitor (PI)‐based regimen (indinavir) had a negative effect on adherence, but adherence tended to improve with time for patients receiving a PI. Patient‐level variance was highly significant and accounted for a third of total variance. Conclusions This work demonstrates that good long‐term adherence can be achieved in the sub‐Saharan context given close monitoring and adherence support measures, confirms the worse adherence for indinavir and underlines the importance of patient heterogeneity.