title: Patient-Initiated Repackaging of Antiretroviral Therapy, Viral Suppression and Drug Resistance.
abstract: Patient-initiated repackaging of antiretroviral therapy (ART) refers to removal of ART medications from their original manufacturer's containers, and putting them into alternative containers. This behavior may be triggered by stigma associated with HIV infection, and may impact patient outcomes. We assessed association between patient initiated repackaging of ART and failure to achieve viral suppression (FVS) in a sample of 450 HIV-infected adults (≥8 years) on first line ART for ≥6 months. FVS was defined as a plasma HIV RNA level ≥400 copies/mL. A total of 197 (43.7%) patients reported repackaging their ART medications. One hundred ninety-one patients (42.4%) failed to suppress and FVS was associated with medication repackaging [adjusted odds ratio (aOR), 2.2; 95% CI 1.4-3.3.] Adherence to ART was also associated with FVS (aOR; 0.4; 95% CI 0.2-0.6.). Benefits of retaining drugs in their original packaging along with adherence to ART should be emphasized to reduce the risk of FVS.
authors.affiliation: Kilimanjaro Christian Medical Centre, (KCMC), Kilimanjaro, P.O Box 3010, Moshi, Tanzania. habibrama@gmail.com.|Kilimanjaro Christian Medical University College, Moshi, Tanzania. habibrama@gmail.com.
authors.forename: Habib O
authors.initials: HO
authors.lastname: Ramadhani
authors.affiliation: Duke Global Health Institute, Durham, NC, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Muiruri
authors.affiliation: Kilimanjaro Christian Medical Centre, (KCMC), Kilimanjaro, P.O Box 3010, Moshi, Tanzania.|Mawenzi Regional Hospital, Moshi, Tanzania.
authors.forename: Venance P
authors.initials: VP
authors.lastname: Maro
authors.affiliation: Kilimanjaro Christian Medical Centre, (KCMC), Kilimanjaro, P.O Box 3010, Moshi, Tanzania.|Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Balthazar
authors.initials: B
authors.lastname: Nyombi
authors.affiliation: Duke Global Health Institute, Durham, NC, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Omondi
authors.affiliation: Kilema Designated District Hospital, Moshi, Tanzania.
authors.forename: Julian B
authors.initials: JB
authors.lastname: Mushi
authors.affiliation: Kibosho Designated District Hospital, Moshi, Tanzania.
authors.forename: Eileen S
authors.initials: ES
authors.lastname: Lirhunde
authors.affiliation: Duke Global Health Institute, Durham, NC, USA.|Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Bartlett
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D004349:Drug Packaging; D004351:Drug Resistance; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D057545:Social Stigma; D013636:Tanzania; D019562:Viral Load / Q000187:drug effects*; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: ART resistance mutations; HIV; Repackaging of anti-retro-viral; Stigma; Virological suppression