Evaluating Adherence to Highly Active Antiretroviral Therapy with Use of Pill Counts and Viral Load Measurement in the Drug Resources Enhancement against AIDS and Malnutrition Program in Mozambique

Community of Sant'Egidio, Drug Resources Enhancement against AIDS and Malnutrition Program, Rome, Italy.
Clinical Infectious Diseases (Impact Factor: 8.89). 05/2008; 46(10):1609-16. DOI: 10.1086/587659
Source: PubMed


Maintaining treatment adherence among the growing number of patients receiving antiretroviral treatment in Africa is a dramatic challenge. The objective of our study was to explore the results of a computerized pill count method and to test the validity, sensitivity, and specificity of this method with respect to viral load measurement in an African setting.
We performed a prospective, observational study involving patients who received first-line highly active antiretroviral therapy in Mozambique from 1 April 2005 through 31 March 2006. Enrolled patients had received treatment for at least 3 months before the study. For defining treatment adherence levels, pill counts were used, and the results were analyzed with viral load measurements at the end of the observation period.
The study involved 531 participants. During the 12 months of observation, 137 patients left the program or discontinued first-line therapy. Of the remaining 394 patients, 284 (72.1%) had >95% treatment adherence; of those 284 patients, 274 (96.5%) had a final viral load <1000 copies/mL. A Cox proportional hazards analysis revealed that the relationship between >95% treatment adherence and the final viral load was closer than that between >90% treatment adherence and viral load.
Treatment adherence >95% maximizes the results of the nonnucleoside reverse-transcriptase inhibitor-based regimen. The pill count method appears to be a reliable and economic tool for monitoring treatment adherence in resource-limited settings.

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    • "Recent evidence suggests that non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimens may be more forgiving of minor deviations in adherence (Bangsberg 2006). Nevertheless, the essential relationship between adherence and UDVL remains: superb adherence to NNRTIs is rewarded by the highest rates of virologic success (Nachega et al. 2007; San Lio et al. 2008). A core question in the NNRTI/adherence debate is whether the commonly accepted definition of 'optimal adherence' based around the C95% threshold is appropriately strict, or overly strict. "
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    • " 2003; Landman et al. 2003; Laniece et al. 2003; Laurent et al. 2004; Laurent et al. 2005a, b; Mills et al. 2006b; Nachega et al. 2004; Orrell et al. 2003; Oyugi et al. 2004; Remien et al. 2003; San Lio et al. 2008; Tadios and Davey 2006; Weidle et al. 2002; Weidle et al. 2006; Weiser et al. 2003) there has been little discussion about how HIV? women balance the demands of adherence to HIV ART, childcare, and antiretroviral adherence among their children who are HIV-infected. Motherhood potentially places particular stress on HIV-infected women due to higher levels of depression, poorer family cohesion, less ability to perform daily functions, and the need to care for HIV-infected children (Murphy et al. 2002). "
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