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Bull World Health Organ. 2015 Aug 1;93(8):529-39. doi: 10.2471/BLT.14.147447. Epub 2015 May 27.

Monitoring of HIV treatment in seven countries in the WHO Region of the Americas.

Author information

1
Clínica de Inmuno-Infectología, Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Calle Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, México Distrito Federal, CP 14080, Mexico .
2
Department of Biostatistics, Vanderbilt University, Nashville, United States of America (USA).
3
Instituto de Pesquisa Clínica Evandro Chagas, Fundacão Oswaldo Cruz, Rio de Janeiro, Brazil .
4
Fundación Huésped, Buenos Aires, Argentina .
5
Fundación Arriarán, Universidad de Chile, Santiago, Chile .
6
Le Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti .
7
Instituto Hondureño de Seguridad Social and Hospital Escuela, Tegucigalpa, Honduras .
8
Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru .
9
Department of Medicine, Vanderbilt University, Nashville, USA .

Abstract

in English, Arabic, Chinese, French, Russian, Spanish

OBJECTIVE:

To determine the prevalence of adequate monitoring and the costs of measuring CD4+ T-lymphocytes (CD4+ cell) and human immunodeficiency virus (HIV) viral load in people receiving antiretroviral therapy (ART) in seven countries in the WHO Region of the Americas.

METHODS:

We obtained retrospective, longitudinal data for 14 476 adults who started a first ART regimen at seven HIV clinics in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru between 2000 and 2011. We estimated the proportion of 180-day periods with adequate monitoring, which we defined as at least one CD4+ cell count and one viral load measurement. Factors associated with adequate monitoring were analysed using regression methods. The costs of the tests were estimated.

FINDINGS:

The median follow-up time was 50.4 months; the proportion of 180-day periods with adequate CD4+ cell counts was 69% while the proportion with adequate monitoring was 62%. Adequate monitoring was more likely in participants who were older, who started ART more recently, whose first regimen included a non-nucleoside reverse transcriptase inhibitor or who had a CD4+ cell count less than 200 cells/µl at ART initiation. The cost of one CD4+ cell count ranged from 7.37 United States dollars (US$) in Argentina to US$ 64.09 in Chile; the cost of one viral load measurement ranged from US$ 20.34 in Brazil to US$ 186.28 in Haiti.

CONCLUSION:

In HIV-infected participants receiving ART in the WHO Region of the Americas, CD4+ cell count and viral load monitoring was often carried out less frequently than regional guidelines recommend. The laboratory costs of monitoring varied greatly.

PMID:
26478610
PMCID:
PMC4581655
DOI:
10.2471/BLT.14.147447
[Indexed for MEDLINE]
Free PMC Article

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