Contrasting predictors of poor antiretroviral therapy outcomes in two South African HIV programmes: a cohort study

Dahab, Mison; Charalambous, Salome; Karstaedt, Alan S.; Fielding, Katherine L.; Hamilton, Robin; La Grange, Lettie; Churchyard, Gavin J.; Grant, Alison D.
January 2010
BMC Public Health;2010, Vol. 10 Issue 1, p430
Academic Journal
Background: Many national antiretroviral therapy (ART) programmes encourage providers to identify and address baseline factors associated with poor treatment outcomes, including modifiable adherence-related behaviours, before initiating ART. However, evidence on such predictors is scarce, and providers judgement may often be inaccurate. To help address this evidence gap, this observational cohort study examined baseline factors potentially predictive of poor treatment outcomes in two ART programmes in South Africa, with a particular focus on determinants of adherence. Methods: Treatment-naïve patients starting ART were enrolled from a community and a workplace ART programme. Potential baseline predictors associated with poor treatment outcomes (defined as viral load > 400 copies/ml or having discontinued treatment by six months) were assessed using logistic regression. Exposure variables were organised for regression analysis using a hierarchical framework. Results: 38/227 (17%) of participants in the community had poor treatment outcomes compared to 47/117 (40%) in the workplace. In the community, predictors of worse outcomes included: drinking more than 20 units of alcohol per week, having no prior experience of chronic medications, and consulting a traditional healer in the past year (adjusted odds ratio [aOR] 15.36, 95% CI 3.22-73.27; aOR 2.30, 95%CI 1.00-5.30; aOR 2.27, 95% CI 1.00-5.19 respectively). Being male and knowing someone on ART were associated with better outcomes (aOR 0.25, 95%CI 0.09-0.74; aOR 0.44, 95%CI 0.19-1.01 respectively). In the workplace, predictors of poor treatment outcomes included being uncertain about the health effects of ART and a traditional healer's ability to treat HIV (aOR 7.53, 95%CI 2.02-27.98; aOR 4.40, 95%CI 1.41-13.75 respectively). Longer pre-ART waiting time (2-12 weeks compared to <2 weeks) predicted better treatment outcomes (aOR 0.13, 95% CI 0.03-0.56). Conclusion: Baseline predictors of poor treatment outcomes were largely unique to each programme, likely reflecting different populations and pathways to HIV care. In the workplace, active promotion of HIV testing may have extended ART to individuals who, without provider initiation, would not have spontaneously sought care. As provider-initiated testing makes ART available to individuals less motivated to seek care, patients may need additional adherence support, especially addressing uncertainty about the health benefits of ART.


Related Articles

  • Use of Highly Active Antiretroviral Therapy in a Cohort of HIV-Seropositive Women. Cook, Judith A.; Cohen, Mardge H.; Grey, Dennis; Kirstein, Lynn; Burke, Jane; Anastos, Kathryn; Palacio, Herminia; Richardson, Jean; Wilson, Tracey E.; Young, Mary // American Journal of Public Health;Jan2002, Vol. 92 Issue 1, p82 

    Objectives. This study examined longitudinal trends in use of highly active antiretroviral therapy (HAART) among a cohort of HIV-positive participants in the Women's Interagency HIV Study. Methods. Beginning in 1994, 1690 HIV-positive women reported detailed information about their use of...

  • Viral Decay Kinetics in the Highly Active Antiretroviral Therapy-Treated Rhesus Macaque Model of AIDS. Deere, Jesse D.; Higgins, Joanne; Cannavo, Elda; Villalobos, Andradi; Adamson, Lourdes; Fromentin, Emilie; Schinazi, Raymond F.; Luciw, Paul A.; North, Thomas W. // PLoS ONE;2010, Vol. 5 Issue 7, p1 

    To prevent progression to AIDS, persons infected with human immunodeficiency virus type 1 (HIV-1) must remain on highly active antiretroviral therapy (HAART) indefinitely since this modality does not eradicate the virus. The mechanisms involved in viral persistence during HAART are poorly...

  • Didanosine/nevirapine/zidovudine.  // Reactions Weekly;8/11/2007, Issue 1164, p13 

    The article describes the case of a woman who developed nodular regenerative hyperplasia during treatment with highly active antiretroviral therapy (HAART), including didanosine, nevirapine and zidovudine, for HIV infection. The patient, who had a history of liver fracture and had been diagnosed...

  • Relationship between HIV/Highly Active Antiretroviral Therapy (HAART)—Associated Lipodystrophy Syndrome and Stavudine-Triphosphate Intracellular Levels in Patients with Stavudine-Based Antiretroviral Regimens. Domingo, Pere; Cabeza, Maria Carmen; Pruvost, Alain; Salazar, Juliana; del Mar Gutierrez, Maria; Mateo, Maria Gracia; Domingo, Joan C.; Fernandez, Irene; Villarroya, Francesc; Muñoz, Jessica; Vidal, Francesc; Baiget, Montserrat // Clinical Infectious Diseases;4/1/2010, Vol. 50 Issue 7, p1033 

    Background. The link between human immunodeficiency virus/highly active antiretroviral therapy (HAART)- associated lipodystrophy syndrome (HALS) and the use of thymidine analogues has been well established. However, to our knowledge, no relationship has been proven between intracellular levels...

  • Therapy for HIV: Past, Present, and Future. Peters, B.S.; Conway, K. // Advances in Dental Research;Apr2011, Vol. 23 Issue 1, p23 

    Initial therapies for HIV infection comprised nucleoside analogues, but as single or dual agents, they failed to prevent disease progression. When a new class of drug was introduced, the protease inhibitors, an effective triple therapy became possible—namely, highly active antiretroviral...

  • The Safety of Interruption of HAART in Patients Who Never Met the Current Criteria for HIV Treatment Initiation. Deresinski, Stan // Clinical Infectious Diseases;9/15/2006, Vol. 43 Issue 6, pvi 

    The article discusses the research "Safe Treatment interruptions in patients with nadir CD4 counts of more than 350 cells/μL: a randomized trial," published in the 2006 issue of the "Journal of Acquired Immune Deficiency Syndrome" which evaluates the safety of the discontinuation of highly...

  • Importance of Dose Timing to Achieving Undetectable Viral Loads. Gill, Christopher J.; Sabin, Lora L.; Hamer, Davidson H.; Xu Keyi; Zhang Jianbo; Tao Li; Wan-Ju Wu; Wilson, Ira B.; DeSilva, Mary Bachman // AIDS & Behavior;Aug2010, Vol. 14 Issue 4, p785 

    Little is known about the importance of dose timing to successful antiretroviral therapy (ART). In a cohort comprised of Chinese HIV/AIDS patients, we measured adherence among subjects for 6 months using three methods in parallel: self-report using a visual analog scale (SR-VAS), pill count, and...

  • HIV Antiretroviral Drug Resistance. Campo, Jose E.; Jamjian, Christine; Goulston, Claudia // Journal of AIDS & Clinical Research;Special2012, Vol. 3 Issue S, Special section p1 

    The article describes some of the challenges in the use of highly active antiretroviral therapy (HAART) from the perspective of HIV resistance. It defines drug resistance in HIV as a reduced susceptibility to a specific antiretroviral (ARV) and has been documented since the introduction of ARV...

  • Benefit or Toxicity from Neurologically Targeted Antiretroviral Therapy? Brew, Bruce J. // Clinical Infectious Diseases;3/15/2010, Vol. 50 Issue 6, p930 

    In this article, the author discusses the treatment of HIV-related neurocognitive disorders. The author states that milder forms of HIV-related neurocognitive diseases are more usual than HIV-related dementia and have not altered with using highly active antiretroviral therapy (HAART). The...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics