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Secure antiretroviral therapy delivery in a resource‐limited setting: streamlined to minimize drug resistance and expense
Author(s) -
Kitkungvan D,
Apisarnthanarak A,
Laowansiri P,
Mundy LM
Publication year - 2008
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/j.1468-1293.2008.00611.x
Subject(s) - medicine , nevirapine , viral load , lamivudine , pill , stavudine , hiv drug resistance , rash , confidence interval , antiretroviral therapy , emergency medicine , human immunodeficiency virus (hiv) , pharmacology , immunology , virus , hepatitis b virus
Background We report the design and analysis of a streamlined approach to the delivery of antiretroviral therapy (ART) that minimized risk for emergence of ART drug resistance (ART‐DR) in a resource‐limited setting. Methods The algorithm of care for persons with HIV comprised generic, fixed‐dose, twice‐daily stavudine, lamivudine and nevirapine (GPO‐VIR), scheduled and unannounced pill counts and measurement of viral load at months 6 and 18 after initiation of ART. We evaluated adherence as measured by pill counts, HIV suppression and programmatic costs. Results Over a 4‐year period, 214 of 330 patients (64.8%) were enrolled; baseline median CD4 count was 84 cells/μL. At month 1, nine patients (4.2%) discontinued GPO‐VIR because of skin rash. At month 6, 199 patients (93%) achieved viral load ≤400 HIV‐1 RNA copies/mL, with current alcohol use the sole predictor of treatment failure [adjusted Relative Risk (aRR)=1.67; 95% confidence interval=1.05–2.48; P <0.001]. Most patients (97%) with HIV suppression at month 6 had viral loads ≤50 copies/mL at month 18; all had ≥75% visit compliance and 192 (98%) had ≥75% adherence measured by pill counts. The estimated annual costs were $111.92 per patient for the pill counts, home visits and viral load measurement. Conclusions Secure ART delivery, while minimizing risk for non‐adherence and ART‐DR, is clinically and economically feasible in this resource‐limited setting.