Document Detail


The impact of first year adherence to antiretroviral therapy on long-term clinical and immunological outcomes in the DART trial in Uganda and Zimbabwe.
MedLine Citation:
PMID:  22463596     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To describe associations between different summaries of adherence in the first year on antiretroviral therapy (ART) and the subsequent risk of mortality, to identify patients at high risk because of early adherence behaviour.
METHODS: We previously described an approach where adherence behaviour at successive clinic visits during the first year on ART was seen as a Markov chain (MC), and the individually estimated transition probabilities between 'good', 'poor' and 'non-response' adherence states were used to classify HIV-infected adults in the DART trial into subgroups with similar behaviour. The impact of this classification and classifications based on traditional 'averaged' measures [mean drug possession ratio (DPR) and self-reported adherence] were compared in terms of their impact on longer-term mortality over the 2-5 years on ART using Cox proportional hazards models.
RESULTS: Of 2960 participants in follow-up after 1 year on ART, 29% had never missed pills in the last month and 11% had 100% DPR throughout the first year. The poorest adherers by self-reported measures were more likely to have only none/primary education (P < 0.01). Being in the poorest adherence subgroup by MC and DPR was independently associated with increased mortality [HR = 1.57 (95% CI 1.02, 2.42); 1.82 (1.32, 2.51) respectively].
CONCLUSIONS: Classification based on dynamic adherence behaviour is associated with mortality independently of DPR. The classifications could be useful in understanding adherence, targeting focused interventions and improving longer-term adherence to therapy.
Authors:
S Kiwuwa-Muyingo; A S Walker; H Oja; J Levin; G Miiro; E Katabira; C Kityo; J Hakim; J Todd;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-03-30
Journal Detail:
Title:  Tropical medicine & international health : TM & IH     Volume:  17     ISSN:  1365-3156     ISO Abbreviation:  Trop. Med. Int. Health     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-09-06     Completed Date:  2012-12-05     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  9610576     Medline TA:  Trop Med Int Health     Country:  England    
Other Details:
Languages:  eng     Pagination:  584-94     Citation Subset:  IM    
Copyright Information:
© 2012 Blackwell Publishing Ltd.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anti-HIV Agents / therapeutic use*
Antiretroviral Therapy, Highly Active / methods*
Female
Follow-Up Studies
HIV Infections / drug therapy*,  immunology
Humans
Male
Markov Chains
Patient Compliance / statistics & numerical data*
Proportional Hazards Models
Questionnaires
Treatment Outcome
Uganda
Zimbabwe
Grant Support
ID/Acronym/Agency:
G0600344//Medical Research Council; MC_U122886352//Medical Research Council; //Medical Research Council
Chemical
Reg. No./Substance:
0/Anti-HIV Agents
Investigator
Investigator/Affiliation:
H Grosskurth / ; P Munderi / ; G Kabuye / ; D Nsibambi / ; R Kasirye / ; E Zalwango / ; M Nakazibwe / ; B Kikaire / ; G Nassuna / ; R Massa / ; K Fadhiru / ; M Namyalo / ; A Zalwango / ; L Generous / ; P Khauka / ; N Rutikarayo / ; W Nakahima / ; A Mugisha / ; J Todd / ; J Levin / ; S Muyingo / ; A Ruberantwari / ; P Kaleebu / ; D Yirrell / ; N Ndembi / ; F Lyagoba / ; P Hughes / ; M Aber / ; A Medina Lara / ; S Foster / ; J Amurwon / ; B Nyanzi Wakholi / ; K Wangati / ; B Amuron / ; D Kajungu / ; J Nakiyingi / ; W Omony / ; K Fadhiru / ; D Nsibambi / ; P Khauka / ; P Mugyenyi / ; C Kityo / ; F Ssali / ; D Tumukunde / ; T Otim / ; J Kabanda / ; H Musana / ; J Akao / ; H Kyomugisha / ; A Byamukama / ; J Sabiiti / ; J Komugyena / ; P Wavamunno / ; S Mukiibi / ; A Drasiku / ; R Byaruhanga / ; O Labeja / ; P Katundu / ; S Tugume / ; P Awio / ; A Namazzi / ; G T Bakeinyaga / ; H Katabira / ; D Abaine / ; J Tukamushaba / ; W Anywar / ; W Ojiambo / ; E Angweng / ; S Murungi / ; W Haguma / ; S Atwiine / ; J Kigozi / ; L Namale / ; A Mukose / ; G Mulindwa / ; D Atwiine / ; A Muhwezi / ; E Nimwesiga / ; G Barungi / ; J Takubwa / ; S Murungi / ; D Mwebesa / ; G Kagina / ; M Mulindwa / ; F Ahimbisibwe / ; P Mwesigwa / ; S Akuma / ; C Zawedde / ; D Nyiraguhirwa / ; C Tumusiime / ; L Bagaya / ; W Namara / ; J Kigozi / ; J Karungi / ; R Kankunda / ; R Enzama / ; A Latif / ; J Hakim / ; V Robertson / ; A Reid / ; E Chidziva / ; R Bulaya-Tembo / ; G Musoro / ; F Taziwa / ; C Chimbetete / ; L Chakonza / ; A Mawora / ; C Muvirimi / ; G Tinago / ; P Svovanapasis / ; M Simango / ; O Chirema / ; J Machingura / ; S Mutsai / ; M Phiri / ; T Bafana / ; M Chirara / ; L Muchabaiwa / ; M Muzambi / ; E Chigwedere / ; M Pascoe / ; C Warambwa / ; E Zengeza / ; F Mapinge / ; S Makota / ; A Jamu / ; N Ngorima / ; H Chirairo / ; S Chitsungo / ; J Chimanzi / ; C Maweni / ; R Warara / ; M Matongo / ; S Mudzingwa / ; M Jangano / ; K Moyo / ; L Vere / ; I Machingura / ; E Katabira / ; A Ronald / ; A Kambungu / ; F Lutwama / ; I Mambule / ; A Nanfuka / ; J Walusimbi / ; E Nabankema / ; R Nalumenya / ; T Namuli / ; R Kulume / ; I Namata / ; L Nyachwo / ; A Florence / ; A Kusiima / ; E Lubwama / ; R Nairuba / ; F Oketta / ; E Buluma / ; R Waita / ; H Ojiambo / ; F Sadik / ; J Wanyama / ; P Nabongo / ; J Oyugi / ; F Sematala / ; A Muganzi / ; C Twijukye / ; H Byakwaga / ; R Ochai / ; D Muhweezi / ; A Coutinho / ; B Etukoit / ; C Gilks / ; K Boocock / ; C Puddephatt / ; C Grundy / ; J Bohannon / ; D Winogron / ; J Darbyshire / ; D M Gibb / ; A Burke / ; D Bray / ; A Babiker / ; A S Walker / ; H Wilkes / ; M Rauchenberger / ; S Sheehan / ; C Spencer-Drake / ; K Taylor / ; M Spyer / ; A Ferrier / ; B Naidoo / ; D Dunn / ; R Goodall / ; R Nanfuka / ; C Mufuka-Kapuya / ; P Kaleebu / ; D Pillay / ; V Robertson / ; D Yirrell / ; S Tugume / ; M Chirara / ; P Katundu / ; N Ndembi / ; F Lyagoba / ; D Dunn / ; R Goodall / ; A McCormick / ; A Medina Lara / ; S Foster / ; J Amurwon / ; B Nyanzi Wakholi / ; J Kigozi / ; L Muchabaiwa / ; M Muzambi / ; I Weller / ; A Babiker / ; S Bahendeka / ; M Bassett / ; A Chogo Wapakhabulo / ; J Darbyshire / ; B Gazzard / ; C Gilks / ; H Grosskurth / ; J Hakim / ; A Latif / ; C Mapuchere / ; O Mugurungi / ; P Mugyenyi / ; C Burke / ; M Distel / ; S Jones / ; E Loeliger / ; P Naidoo / ; C Newland / ; G Pearce / ; S Rahim / ; J Rooney / ; M Smith / ; W Snowden / ; J-M Steens / ; A Breckenridge / ; A McLaren / ; C Hill / ; J Matenga / ; A Pozniak / ; D Serwadda / ; T Peto / ; A Palfreeman / ; M Borok / ; E Katabira /

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