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Intensive adherence counselling for HIV‐infected individuals failing second‐line antiretroviral therapy in Johannesburg, South Africa
Author(s) -
Fox Matthew P.,
Berhanu Rebecca,
Steegen Kim,
Firnhaber Cindy,
Ive Prudence,
Spencer David,
Mashamaite Sello,
Sheik Sadiyya,
Jonker Ingrid,
Howell Pauline,
Long Lawrence,
Evans Denise
Publication year - 2016
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/tmi.12741
Subject(s) - medicine , viral load , antiretroviral therapy , drug resistance , first line , protease inhibitor (pharmacology) , human immunodeficiency virus (hiv) , second line , confidence interval , immunology , microbiology and biotechnology , biology
Objective In resource‐limited settings, where genotypic drug resistance testing is rarely performed and poor adherence is the most common reason for treatment failure, programmatic approaches to handling treatment failure are essential. This study was performed to describe one such approach to adherence optimisation. Methods This was a single‐arm study of patients on second‐line protease inhibitor ( PI )‐based antiretroviral therapy ( ART ) with a HIV ‐1 RNA ≥400 copies/ml in Johannesburg, South Africa, between 1 March 2012 and 1 December 2013. Patients underwent enhanced adherence counselling. Those with improved adherence and a repeat viral load of >1000 copies/ml underwent HIV ‐1 drug resistance testing. We describe results using simple proportions and 95% confidence intervals. Results Of the 400 patients who underwent targeted adherence counselling after an elevated viral load on second‐line ART , 388 (97%) underwent repeat viral load testing. Most of these ( n = 249; 64%, 95% CI 59–69) resuppressed (<400 copies/ml) on second line. By the end of follow‐up (1 March 2014), among the 139 (36%, 95% CI : 31–41%), who did not initially resuppress after being targeted, 106 had a viral load >400 copies/ml, 11 switched to third line, 5 were awaiting third line, 4 had died and 13 were lost to follow‐up. Among the unsuppressed, 48 successfully underwent resistance testing with some resistance detected in most (41/48). Conclusions Most (64%) second‐line treatment failure in this clinic is related to adherence and can be overcome with careful adherence support. Controlled interventions are needed to determine what the optimal approach is to improving second‐line outcomes and reducing the need for third‐line ART .