title: Low prevalence of detectable HIV plasma viremia in patients treated with antiretroviral therapy in Burkina Faso and Mali.
abstract: BACKGROUND
  Sub-Saharan Africa has seen dramatic increases in the numbers of people treated with antiretroviral therapy (ART). Although standard ART regimens are now universally applied, viral load measurement is not currently part of standard monitoring protocols in sub-Saharan Africa.
  
  
  METHODS
  We describe the prevalence of inadequate virological response (IVR) to ART (viral load >or= 500 copies/mL) and identify factors associated with this outcome in 606 HIV-positive patients treated for at least 6 months. Recruitment took place in 7 hospitals and community-based sites in Bamako and Ouagadougou, and information was collected using medical charts and interviews.
  
  
  RESULTS
  The overall prevalence of IVR in treatment-naive patients was 12.3% and 24.4% for pretreated patients. There were no differences in rates of IVR according to ART delivery sites and time on treatment. Patients living farther away [odds ratio (OR) = 2.48; 95% confidence interval (CI) 1.40 to 4.39], those on protease inhibitor or nucleoside reverse transcriptase inhibitor regimens (OR = 3.23; 95% CI 1.79 to 5.82) and those reporting treatment interruptions (OR = 2.36; 95% CI 1.35 to 4.15), had increased odds of IVR. Immune suppression (OR = 3.32, 95% CI 1.94 to 5.70) and poor self-rated health (OR = 2.00; 95% CI 1.17 to 3.41) were also associated with IVR.
  
  
  CONCLUSIONS
  Sufficient expertise and dedication exist in public hospital and community-based programs to achieve rates of treatment success comparable to better-resourced settings.
authors.affiliation: Institute for Health and Social Policy-McGill University, Montreal, Quebec, Canada. catherine.boileau@mcgill.ca
authors.forename: Catherine
authors.initials: C
authors.lastname: Boileau
authors.forename: Vinh-Kim
authors.initials: VK
authors.lastname: Nguyen
authors.forename: Mohamed
authors.initials: M
authors.lastname: Sylla
authors.forename: Nima
authors.initials: N
authors.lastname: Machouf
authors.forename: Annie
authors.initials: A
authors.lastname: Chamberland
authors.forename: Hamar A
authors.initials: HA
authors.lastname: Traoré
authors.forename: Pascal A
authors.initials: PA
authors.lastname: Niamba
authors.forename: Ismaël
authors.initials: I
authors.lastname: Diallo
authors.forename: Moussa
authors.initials: M
authors.lastname: Maïga
authors.forename: Mamadou
authors.initials: M
authors.lastname: Cissé
authors.forename: Sélim
authors.initials: S
authors.lastname: Rashed
authors.forename: Cécile
authors.initials: C
authors.lastname: Tremblay
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002050:Burkina Faso / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D003151:Community Health Centers; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification; D006773:Hospitals, Municipal; D006801:Humans; D008297:Male; D008302:Mali / Q000453:epidemiology; D016017:Odds Ratio; D010349:Patient Compliance; D010865:Pilot Projects; D012307:Risk Factors; D016896:Treatment Outcome; D019562:Viral Load