title: Early warning indicators for first-line virologic failure independent of adherence measures in a South African urban clinic.
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.
authors: 1 Department of Medicine/Infectious Disease, School of Medicine, Emory University , Atlanta, Georgia .
authors: Vincent C
authors: VC
authors: Marconi
authors: Baohua
authors: B
authors: Wu
authors: Jane
authors: J
authors: Hampton
authors: Claudia E
authors: CE
authors: Ordóñez
authors: Brent A
authors: BA
authors: Johnson
authors: Dinesh
authors: D
authors: Singh
authors: Sally
authors: S
authors: John
authors: Michelle
authors: M
authors: Gordon
authors: Anna
authors: A
authors: Hare
authors: Richard
authors: R
authors: Murphy
authors: Jean
authors: J
authors: Nachega
authors: Daniel R
authors: DR
authors: Kuritzkes
authors: Carlos
authors: C
authors: del Rio
authors: Henry
authors: H
authors: Sunpath
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects*; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D011159:Population Surveillance; D012372:ROC Curve; D012307:Risk Factors; D012959:Socioeconomic Factors; D013019:South Africa; D013997:Time Factors; D017211:Treatment Failure; D019562:Viral Load; D014944:World Health Organization
chemical_list: D019380:Anti-HIV Agents