PMID- 28899102
OWN - NLM
STAT- MEDLINE
DCOM- 20180130
LR  - 20180308
IS  - 1931-8405 (Electronic)
IS  - 0889-2229 (Linking)
VI  - 33
IP  - 12
DP  - 2017 Dec
TI  - Community Based Antiretroviral Treatment in Rural Zimbabwe.
PG  - 1185-1191
LID - 10.1089/aid.2017.0029 [doi]
AB  - Treatment of HIV has reduced HIV/AIDS-related mortality. Sustaining >90%
      virologic suppression in sub-Saharan Africa requires decentralized care and
      prevention services to rural communities. In Zimbabwe, the number of people
      receiving antiretroviral treatment (ART) has increased rapidly. However, access
      to treatment monitoring tools such as viral load and drug resistance testing is
      limited. We assessed virologic treatment outcomes among ART recipients in
      Nyamutora, a rural community receiving bimonthly ART and prevention services. We 
      enrolled all ART recipients (143) at 6-monthly visits in the Nyamutora community 
      in 2014 and 2015. Whole blood samples were collected in K-EDTA tubes, transported
      to Harare for CD4 counts and viral load testing, and genotype was obtained in
      participants with viral loads >1,000 copies/ml. Ages ranged from 2 to 75 years
      (median 43 years) with a median 42 months on ART at follow-up. Eight of 143 (6%) 
      had viral loads >1,000 copies/ml at one of the 3 visits, 7 on first-line
      nevirapine (NVP)-based ART and 1 on second-line LPV/r-based ART. Seven
      participants had sequence data available, and five had drug resistance mutations,
      K65R, T69N, K101E, K103N, Y181C/I, M184V, and G190A. Virologic failure (p = .001)
      and drug resistance mutations (p = .01) on first-line NVP-based ART were
      associated with younger age by univariate exact logistic regression. The
      participants had high viral suppression (94%) despite less than optimal (NVP
      based) ART regimens without laboratory monitoring. Virologic failure and drug
      resistance were higher among children and adolescents. Effective ART delivery to 
      the community achieved high rates of virologic suppression and minimal drug
      resistance.
FAU - Chimukangara, Benjamin
AU  - Chimukangara B
AD  - 1 Department of Molecular Biology, Biomedical Research and Training Institute ,
      Harare, Zimbabwe .
AD  - 2 Department of Virology, National Health Laboratory Service, University of
      KwaZulu-Natal , Durban, South Africa .
FAU - Manasa, Justen
AU  - Manasa J
AD  - 3 Department of Medicine, Stanford University School of Medicine , Stanford,
      California.
FAU - Mitchell, Rebecca
AU  - Mitchell R
AD  - 4 Department of Mathematics and Computer Science, Emory University , Atlanta,
      Georgia .
FAU - Nyabadza, Georgina
AU  - Nyabadza G
AD  - 5 African Institute of Biomedical Science and Technology , Harare, Zimbabwe .
FAU - Katzenstein, David
AU  - Katzenstein D
AD  - 3 Department of Medicine, Stanford University School of Medicine , Stanford,
      California.
FAU - Masimirembwa, Collen
AU  - Masimirembwa C
AD  - 5 African Institute of Biomedical Science and Technology , Harare, Zimbabwe .
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20171026
PL  - United States
TA  - AIDS Res Hum Retroviruses
JT  - AIDS research and human retroviruses
JID - 8709376
RN  - 0 (Anti-HIV Agents)
RN  - 0 (Dideoxynucleosides)
RN  - 2494G1JF75 (Lopinavir)
RN  - 99DK7FVK1H (Nevirapine)
RN  - K3GDH6OH08 (Didanosine)
RN  - O3J8G9O825 (Ritonavir)
RN  - WR2TIP26VS (abacavir)
SB  - IM
SB  - X
MH  - Acquired Immunodeficiency Syndrome/*drug therapy/mortality/virology
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Anti-HIV Agents/*therapeutic use
MH  - *Antiretroviral Therapy, Highly Active
MH  - CD4 Lymphocyte Count
MH  - Child
MH  - Child, Preschool
MH  - *Community Health Centers
MH  - Cross-Sectional Studies
MH  - Didanosine/therapeutic use
MH  - Dideoxynucleosides/therapeutic use
MH  - Drug Resistance, Viral/physiology
MH  - Female
MH  - HIV-1/drug effects/genetics
MH  - Humans
MH  - Lopinavir/therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Nevirapine/therapeutic use
MH  - Ritonavir/therapeutic use
MH  - Rural Population
MH  - Treatment Failure
MH  - Viral Load
MH  - Young Adult
MH  - Zimbabwe
OTO - NOTNLM
OT  - *HIV drug resistance
OT  - *Zimbabwe
OT  - *successful ART program
EDAT- 2017/09/14 06:00
MHDA- 2018/01/31 06:00
CRDT- 2017/09/14 06:00
PHST- 2017/09/14 06:00 [pubmed]
PHST- 2018/01/31 06:00 [medline]
PHST- 2017/09/14 06:00 [entrez]
AID - 10.1089/aid.2017.0029 [doi]
AID - 10.1089/AID.2017.0029 [pii]
PST - ppublish
SO  - AIDS Res Hum Retroviruses. 2017 Dec;33(12):1185-1191. doi: 10.1089/aid.2017.0029.
      Epub 2017 Oct 26.