Early warning indicators for first-line virologic failure independent of adherence measures in a South African Urban clinic

Vincent C. Marconi, Baohua Wu, Jane Hampton, Claudia E. Ordóñez, Brent A. Johnson, Dinesh Singh, Sally John, Michelle Gordon, Anna Hare, Richard Murphy, Jean Nachega, Daniel R. Kuritzkes, Carlos Del Rio, Henry Sunpath

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

We sought to develop individual-level Early Warning Indicators (EWI) of virologic failure (VF) for clinicians to use during routine care complementing WHO population-level EWI. A case-control study was conducted at a Durban clinic. Patients after≥5 months of first-line antiretroviral therapy (ART) were defined as cases if they had VF [HIV-1 viral load (VL)>1000 copies/mL] and controls (2:1) if they had VL≤1000 copies/mL. Pharmacy refills and pill counts were used as adherence measures. Participants responded to a questionnaire including validated psychosocial and symptom scales. Data were also collected from the medical record. Multivariable logistic regression models of VF included factors associated with VF (p<0.05) in univariable analyses. We enrolled 158 cases and 300 controls. In the final multivariable model, male gender, not having an active religious faith, practicing unsafe sex, having a family member with HIV, not being pleased with the clinic experience, symptoms of depression, fatigue, or rash, low CD4 counts, family recommending HIV care, and using a TV/radio as ART reminders (compared to mobile phones) were associated with VF independent of adherence measures. In this setting, we identified several key individual-level EWI associated with VF including novel psychosocial factors independent of adherence measures.

Original languageEnglish (US)
Pages (from-to)657-668
Number of pages12
JournalAIDS Patient Care and STDs
Volume27
Issue number12
DOIs
StatePublished - Dec 1 2013

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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    Marconi, V. C., Wu, B., Hampton, J., Ordóñez, C. E., Johnson, B. A., Singh, D., John, S., Gordon, M., Hare, A., Murphy, R., Nachega, J., Kuritzkes, D. R., Del Rio, C., & Sunpath, H. (2013). Early warning indicators for first-line virologic failure independent of adherence measures in a South African Urban clinic. AIDS Patient Care and STDs, 27(12), 657-668. https://doi.org/10.1089/apc.2013.0263