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AIDS Care. 2018 Jul;30(7):863-870. doi: 10.1080/09540121.2017.1417527. Epub 2018 Feb 21.

Social and behavioral factors associated with failing second-line ART - results from a cohort study at the Themba Lethu Clinic, Johannesburg, South Africa.

Author information

1
a Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.
2
b Department of Infectious Diseases , Sahlgrenska Academy, University of Gothenburg , Göteborg , Sweden.
3
c Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.
4
d Center for Global Health & Development , Boston University , Boston , USA.
5
e Department of Epidemiology , Boston University School of Public Health , Boston , USA.

Abstract

Poor adherence is a main challenge to successful second-line ART in South Africa. Studies have shown that patients can re-suppress their viral load following intensive adherence counselling. We identify factors associated with failure to re-suppress on second-line ART. The study was a retrospective cohort study which included HIV-positive adults who experienced an elevated viral load ≥400 copies/ml on second-line ART between January 2013-July 2014, had completed an adherence counselling questionnaire and had a repeat viral load result recorded within 6 months of intensive adherence counselling. Log-binomial regression was used to evaluate the association between patient characteristics and social, behavioral or occupational factors and failure to suppress viral load (≥400 copies/ml). A total of 128 patients were included in the analysis, and of these 39% (n = 50) failed to re-suppress their viral load. Compared to those who suppressed, far more patients who failed to suppress reported living with family (44.2% vs. 23.7%), missing a dose in the past week (53.3% vs. 30.0%), using traditional/herbal medications (63.2% vs. 34.3%) or had symptoms suggestive of depression (57.7% vs. 34.3%). These patient-related factors could be targeted for interventions to reduce the risk for treatment failure and prevent switching to expensive third-line ART.

KEYWORDS:

intensive adherence counselling; resource limited setting; second-line antiretroviral therapy; viral suppression; virologic failure

PMID:
29463102
DOI:
10.1080/09540121.2017.1417527
[Indexed for MEDLINE]

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