Pharmacy refill adherence compared with CD4 count changes for monitoring HIV-infected adults on antiretroviral therapy

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dc.contributor.authorBisson, Gregory P.
dc.contributor.authorGross, Robert
dc.contributor.authorBellamy, Scarlett
dc.contributor.authorChittams, Jesse
dc.contributor.authorHislop, Michael
dc.contributor.authorRegensberg, Leon
dc.contributor.authorFrank, Ian
dc.contributor.authorMaartens, Gary
dc.contributor.authorNachega, Jean B.
dc.date.accessioned2012-07-30T13:14:03Z
dc.date.available2012-07-30T13:14:03Z
dc.date.issued2008-05
dc.descriptionThe original publication is available at http://www.plosmedicine.orgen_ZA
dc.description.abstractBackground World Health Organization (WHO) guidelines for monitoring HIV-infected individuals taking combination antiretroviral therapy (cART) in resource-limited settings recommend using CD4รพ T cell (CD4) count changes to monitor treatment effectiveness. In practice, however, falling CD4 counts are a consequence, rather than a cause, of virologic failure. Adherence lapses precede virologic failure and, unlike CD4 counts, data on adherence are immediately available to all clinics dispensing cART. However, the accuracy of adherence assessments for predicting future or detecting current virologic failure has not been determined. The goal of this study therefore was to determine the accuracy of adherence assessments for predicting and detecting virologic failure and to compare the accuracy of adherence-based monitoring approaches with approaches monitoring CD4 count changes. Methodology and Findings We conducted an observational cohort study among 1,982 of 4,984 (40%) HIV-infected adults initiating non-nucleoside reverse transcriptase inhibitor-based cART in the Aid for AIDS Disease Management Program, which serves nine countries in southern Africa. Pharmacy refill adherence was calculated as the number of months of cART claims submitted divided by the number of complete months between cART initiation and the last refill prior to the endpoint of interest, expressed as a percentage......Conclusions Pharmacy refill adherence assessments were as accurate as CD4 counts for detecting current virologic failure in this cohort of patients on cART and have the potential to predict virologic failure before it occurs. Approaches to cART scale-up in resource-limited settings should include an adherence-based monitoring approach.en_ZA
dc.description.versionAuthor retains the copyrighten_ZA
dc.format.extentp. 777-789 : ill.
dc.identifier.citationBisson, G. P. et al. 2008. Pharmacy refill adherence compared with CD4 count changes for monitoring HIV-infected adults on antiretroviral therapy. PLoS Med, 5(5), e109:777-789 doi:10.1371/journal.pmed. 0050109en_ZA
dc.identifier.issn1549-1676 (online)
dc.identifier.issn1549-1277 (print)
dc.identifier.otherdoi:10.1371/journal.pmed. 0050109
dc.identifier.urihttp://hdl.handle.net/10019.1/21890
dc.language.isoen_ZAen_ZA
dc.publisherPublic Library of Science (PLOS)en_ZA
dc.rights.holderAuthor retains the copyrighten_ZA
dc.subjectPharmacy refill adherence assessmentsen_ZA
dc.subjectCD4 countsen_ZA
dc.subjectVirologic failureen_ZA
dc.subjectCombination antiretroviral therapy (cART)en_ZA
dc.subjectAntiretroviral agents -- Therapeutic useen_ZA
dc.subjectHIV infections -- Treatmenten_ZA
dc.titlePharmacy refill adherence compared with CD4 count changes for monitoring HIV-infected adults on antiretroviral therapyen_ZA
dc.typeArticleen_ZA
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