Premium
Optimal antiretroviral therapy adherence as evaluated by CASE index score tool is associated with virological suppression in HIV‐infected adults in Dakar, Senegal
Author(s) -
Byabene A. K.,
FortesDéguévo L.,
Niang K.,
Manga M. N.,
Bulabula A. N. H.,
Nachega J. B.,
Seydi M.
Publication year - 2017
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.12882
Subject(s) - medicine , logistic regression , antiretroviral therapy , regimen , confidence interval , viral load , cross sectional study , multivariate analysis , human immunodeficiency virus (hiv) , immunology , pathology
Abstract Objective To determine the prevalence and factors associated with optimal antiretroviral therapy ( ART ) adherence and virological failure ( VLF ) among HIV ‐infected adults enrolled in the national ART programme at the teaching hospital of Fann, Dakar, Senegal. Methods Cross‐sectional study from 1 September 2013 to 30 January 2014. Outcomes: (1) optimal ART adherence by the Center for Adherence Support Evaluation ( CASE ) Index Score (>10) and (2) VLF (HIV RNA > 1000 copies/ml). Diagnostic accuracy of CASE Index Score assessed using sensitivity (Se), specificity (Sp), positive predictive value ( PPV ), negative predictive value ( NPV ) and corresponding 95% confidence intervals ( CI s). Multivariate logistic regression analysis was performed to identify independent factors associated with optimal adherence and VLF . Results Of 98 HIV ‐infected patients on ART , 68% were female. The median ( IQR ) age was 42 (20–50) years. A total of 57 of 98 (60%) were on ART more than 3 years, and majority (88%) were on NNRTI ‐based first‐line ART regimen. A total of 79 of 98 (80%) patients reported optimal ART adherence, and only five of 84 (5.9%) had documented VLF . Patients with VLF were significantly more likely to have suboptimal ART adherence (17.7% vs . 2.9%; P = 0.02). CASE Index Score showed the best trade‐off in Se (78.9%, 95% CI : 54.4–93.9%), Sp (20.0%, 95% CI : 11.1–31.7), PPV (22.4, 95% CI : 13.1–34.2%) and NPV (76.5%, 95% CI : 50.1–93.2), when used VLF threshold of HIV RNA >50 copies/ml. Factors independently associated with VLF were CASE Index Score <10 ([ aOR ] = 13.0, 95% CI : 1.1–147.9; P = 0.04) and being a boosted PI ‐based ART regimen ([ aOR ] = 27.0, 95% CI : 2.4–309.4; P = 0.008). Conclusions Optimal ART adherence is achievable in a high proportion of HIV‐infected adults in this study population. CASE Index Score was independently associated with virological outcomes, supporting usefulness of this low‐cost ART adherence monitoring tool in this setting.