title: Assessing the viorologic and adherence benefits of patient-selected HIV treatment partners in a resource-limited setting.
abstract: OBJECTIVE
  To determine the efficacy of patient-selected treatment partners on virologic and adherence outcomes during first-line antiretroviral therapy.
  
  
  METHODS
  Randomized controlled trial. SETTING AND ANALYTICAL APPROACH: Between June 2006 and December 2007, 499 HIV-infected adults in Jos, Nigeria, were randomized to standard of care (SOC) or patient-selected treatment partner-assisted therapy (TPA). Each patient was followed for 48 weeks. Virologic outcomes, adherence to drug pick-up, CD4 cell counts, and mortality are reported.
  
  
  RESULTS
  At week 24, undetectable viral load was achieved by 61.7% of patients in the TPA arm versus 50.2% of those receiving SOC [odds ratio (OR) = 1.58, 95% CI: 1.11 to 2.26, P < 0.05]. There was no significant difference at week 48: 65.3% versus 59.4% for TPA and SOC, respectively (OR = 1.28, 95% CI: 0.89 to 1.84, P > 0.05). The TPA group had more than 3 times the odds of at least 95% drug pickup adherence through week 24 (OR = 3.06, 95% CI: 1.89 to 4.94, P < 0.01) and almost twice the odds through week 48 (OR = 1.95, 95% CI: 1.29 to 2.93, P < 0.01). At week 48, there were no significant differences in CD4 cell count increases (t = -0.09, df = 404, P > 0.05) or mortality (10.6% vs. 6.1%) between TPA vs. SOC, respectively. Residence-to-clinic distance was significantly associated with virologic and adherence outcomes.
  
  
  CONCLUSIONS
  Use of patient-selected treatment partners was associated with improved drug pickup adherence and initial virologic success but had no durable effect on attaining undetectable viral load.
authors.affiliation: Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, 645 N Michigan Avenue, Suite 900, Chicago, IL 60611, USA. taiwo@northwestern.edu
authors.forename: Babafemi O
authors.initials: BO
authors.lastname: Taiwo
authors.forename: John A
authors.initials: JA
authors.lastname: Idoko
authors.forename: Leah J
authors.initials: LJ
authors.lastname: Welty
authors.forename: Ihedinachi
authors.initials: I
authors.lastname: Otoh
authors.forename: Grace
authors.initials: G
authors.lastname: Job
authors.forename: Paul G
authors.initials: PG
authors.lastname: Iyaji
authors.forename: Oche
authors.initials: O
authors.lastname: Agbaji
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Agaba
authors.forename: Robert L
authors.initials: RL
authors.lastname: Murphy
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality / Q000821:virology; D006801:Humans; D008297:Male; D009549:Nigeria; D016896:Treatment Outcome; D019562:Viral Load; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents