TITLE

The Use of Pill Counts as a Facilitator of Adherence with Antiretroviral Therapy in Resource Limited Settings

AUTHOR(S)
Achieng, Loice; Musangi, Helen; Billingsley, Katherine; Onguit, Sharon; Ombegoh, Edwin; Bryant, LeeAnn; Mwiindi, Jonathan; Smith, Nathaniel; Keiser, Philip
PUB. DATE
December 2013
SOURCE
PLoS ONE;Dec2013, Vol. 8 Issue 12, p1
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background:Pill counts are often used to measure adherence to ART, but there is little data on how they affect adherence. We previously showed a bivariate relationship between clinicians counting pills and adherence in patients receiving HIV care in Kenya. We present a secondary analysis of the relationship between numbers of pill counts and clinical outcomes in resource limited settings Methods:Patients initiating ART at Kijabe Hospital were monitored for the number of discretionary pill counts performed by their clinician in the first 6 months of ART. Subjects were followed for at least 1 year after enrollment. The number of clinician pill counts was correlated to ART adherence. The primary endpoints were time to treatment failure, defined as a detectable HIV-1 viral load, death; or loss to follow-up. Results:Clinician pill counts were done at 68% of clinic visits for 304 subjects. There was a positive correlation between the number of clinician pill counts and ART adherence (r = 0.21, p <0.001). Patients were divided into 3 groups (0 counts, 1 to 3 counts, 4 to 7 counts) and exhibited adherence of 76%, 84%, and 92%, respectively (p = 0.004). Time to treatment failure for these groups was 220 days, 438 days, and 497 days (P<0.01), respectively. Time to virologic failure in living patients remaining in the cohort was longer in those with more pill count (P =0.02). Multi-variate analysis adjusting for co-variates affecting time to treatment failure found that that clinician pill counts were associated with a decreased risk of treatment failure (HR = 0.69, p =0.04). Conclusions:The number of clinician pill count performed was independently associated with better adherence and a decreased risk of treatment failure. The use of clinician pill counts should be further studied as an adherence promoter through a randomized clinical trial.
ACCESSION #
93395401

 

Related Articles

  • Risk factors for poor virological outcome at 12 months in a workplace-based antiretroviral therapy programme in South Africa: A cohort study. Fielding, Katherine L.; Charalambous, Salome; Stenson, Amy L.; Pemba, Lindiwe F.; Martin, Des J.; Wood, Robin; Churchyard, Gavin J.; Grant, Alison D. // BMC Infectious Diseases;2008, Vol. 8 Issue 1, Special section p1 

    Background: Reasons for the variation in reported treatment outcomes from antiretroviral therapy (ART) programmes in developing countries are not clearly defined. Methods: Among ART-naïve individuals in a workplace ART programme in South Africa we determined virological outcomes at 12 months,...

  • Efficacy and Safety of Emtricitabine vs Stavudine in Combination Therapy in Antiretroviral-Naive Patients: A Randomized Trial. Saag, Michael S.; Cahn, Pedro; Raffi, François; Wolff, Marcelo; Pearce, Daniel; Molina, Jean-Michel; Powderly, William; Shaw, Audrey L.; Mondou, Elsa; Hinkle, John; Borroto-Esoda, Katyna; Quinn, Joseph B.; Barry, David W.; Rousseau, Franck // JAMA: Journal of the American Medical Association;7/14/2004, Vol. 292 Issue 2, p180 

    Context Emtricitabine is a new, once-daily nucleoside reverse transcriptase inhibitor (NRTI) with potent activity against human immunodeficiency virus (HIV). Objective To assess the efficacy and safety of emtricitabine as compared with stavudine when used with a background regimen of didanosine...

  • Treatment of HIV/AIDS: Do the Dilemmas Only Increase? Sande, Merle A.; Ronald, Allan // JAMA: Journal of the American Medical Association;7/14/2004, Vol. 292 Issue 2, p266 

    Presents an editorial on HIV/AIDS treatment and mentions articles in this issue of "JAMA". Guidelines set by the International AIDS Society-USA (IAS-USA) for HIV care reported in this issue; View that clinical trials using highly active antiretroviral therapy (HAART) should be redirected to...

  • Attendance at an outpatient follow-up clinic by HIV-positive psychiatric patients initiated on ART as inpatients. Nel, Y. M.; Jonsson, G. // South African Journal of Psychiatry;Aug2015, Vol. 21 Issue 3, p98 

    Background. Evidence suggests that the presence of mental illness may be associated with poorer adherence to antiretroviral therapy (ART). There is also a general understanding that patients initiated on ART as inpatients have poorer outcomes than those initiated as outpatients. Negative...

  • Implementation of Mental Health Service Has an Impact on Retention in HIV Care: A Nested Case-Control Study in a Japanese HIV Care Facility. Tominari, Shinjiro; Nakakura, Takahiro; Yasuo, Toshihiko; Yamanaka, Kyoko; Takahashi, Yoshimitsu; Shirasaka, Takuma; Nakayama, Takeo // PLoS ONE;Jul2013, Vol. 8 Issue 7, p1 

    Background:Poor retention in the care of patients with human immunodeficiency virus (HIV) is associated with adverse patient outcomes such as antiretroviral therapy failure and death. Therefore, appropriate case management is required for better patient retention; however, which intervention in...

  • Dried Blood Spots for Viral Load Monitoring in Malawi: Feasible and Effective. Rutstein, Sarah E.; Hosseinipour, Mina C.; Kamwendo, Deborah; Soko, Alice; Mkandawire, Memory; Biddle, Andrea K.; Miller, William C.; Weinberger, Morris; Wheeler, Stephanie B.; Sarr, Abdoulaye; Gupta, Sundeep; Chimbwandira, Frank; Mwenda, Reuben; Kamiza, Steve; Hoffman, Irving; Mataya, Ronald // PLoS ONE;Apr2015, Vol. 10 Issue 4, p1 

    Objectives: To evaluate the feasibility and effectiveness of dried blood spots (DBS) use for viral load (VL) monitoring, describing patient outcomes and programmatic challenges that are relevant for DBS implementation in sub-Saharan Africa. Methods: We recruited adult antiretroviral therapy...

  • Efficacy and Safety of Tenofovir DF vs Stavudine in Combination Therapy in Antiretroviral-Naive Patients: A 3-Year Randomized Trial. Gallant, Joel E.; Staszewski, Schlomo; Pozniak, Anton L.; DeJesus, Edwin; Suleiman, Jamal M. A. H.; Miller, Michael D.; Coakley, Dion F.; Lu, Biao; Toole, John J.; Cheng, Andrew K. // JAMA: Journal of the American Medical Association;7/14/2004, Vol. 292 Issue 2, p191 

    Context Tenofovir disoproxil fumarate (DF) is a once-daily nucleotide analogue reverse transcriptase inhibitor. Objective To evaluate the efficacy and safety of tenofovir DF compared with stavudine in antiretroviral-naive patients. Design, Setting, and Participants A prospective, randomized,...

  • Treatment for Adult HIV Infection: 2004 Recommendations of the International AIDS Society-USA Panel. Yeni, Patrick G.; Hammer, Scott M.; Hirsch, Martin S.; Saag, Michael S.; Schechter, Mauro; Carpenter, Charles C. J.; Fischl, Margaret A.; Gatell, Jose M.; Gazzard, Brian G.; Jacobsen, Donna M.; Katzenstein, David A.; Montaner, Julio S. G.; Richman, Douglas D.; Schooley, Robert T.; Thompson, Melanie A.; Vella, Stefano; Volberding, Paul A. // JAMA: Journal of the American Medical Association;7/14/2004, Vol. 292 Issue 2, p251 

    Context Substantial changes in the field of human immunodeficiency virus (HIV) treatment have occurred in the last 2 years, prompting revision of the guidelines for antiretroviral management of adults with established HIV infection. Objective To update recommendations for physicians who provide...

  • Clinical Trials in Sub-Saharan Africa and Established Standards of Care: A Systematic Review of HIV, Tuberculosis, and Malaria Trials. Kent, David M.; Mwamburi, D. Mkaya; Bennish, Michael L.; Kupelnick, Bruce; Ioannidis, John P. A. // JAMA: Journal of the American Medical Association;7/14/2004, Vol. 292 Issue 2, p237 

    Context The minimum standard of care required for participants in clinical trials conducted in resource-poor settings is a matter of controversy; international documents offer contradictory guidance. Objective To determine whether recently published trials conducted in sub-Saharan Africa met...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

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

Try another library?
Sign out of this library

Other Topics