Impact of drug stock-outs on death and retention to care among HIV-infected patients on combination antiretroviral therapy in Abidjan, Côte d'Ivoire.
Impact of drug stock-outs on death and retention to care among HIV-infected patients on combination antiretroviral therapy in Abidjan, Côte d'Ivoire.
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DOI：
10.1371/journal.pone.0013414
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发表时间：
2010-10-15
期刊：
影响因子：
3.7
通讯作者：
Yazdanpanah Y
中科院分区：
文献类型：
--
作者：
Pasquet A;Messou E;Gabillard D;Minga A;Depoulosky A;Deuffic-Burban S;Losina E;Freedberg KA;Danel C;Anglaret X;Yazdanpanah Y
评价科特迪瓦阿比让抗逆转录病毒药物缺货的类型和频率及其对艾滋病毒感染者死亡和护理中断的影响。我们对2006年2月1日至2007年6月1日期间在三家成人HIV诊所开始联合抗逆转录病毒治疗（cART）的患者进行了一项队列研究。随访于2008年2月1日结束。主要结局是cART方案调整，定义为至少一种药物替代，或因诊所药房药物缺货而停药至少一个月。接受cART治疗至少6个月的患者的次要结局是护理中断或死亡。采用含时间依赖变量的考克斯回归模型评估抗逆转录病毒药物缺货对护理中断或死亡的影响。总体而言，1，554名成年人开始了cART，并接受了平均13.2个月的随访。在此期间，72名患者停止治疗，98名患者因药物缺货而修改了治疗方案。缺货涉及奈韦拉平和固定剂量复方齐多夫定/拉米夫定的病例分别为27%和51%。在1,554例患者中，839例（54%）开始使用固定剂量司他夫定/拉米夫定/奈韦拉平进行cART，并且在研究期间没有面临缺货。在975例接受cART治疗至少6个月的患者中，缺货相关的cART停药增加了治疗中断或死亡的风险（校正后的风险比[HR]，2.83; 95%CI，1.25-6.44），但cART修改没有增加治疗中断或死亡的风险（校正后的HR，1.21; 95%CI，0.46-3.16）。cART缺货影响了至少11%的治疗人群。由于缺货而中断治疗的情况很常见，使中断治疗或死亡的风险增加了一倍。这些缺货不涉及最常见的一线治疗方案。随着撒哈拉以南非洲获得cART的机会继续增加，一线治疗方案应标准化，以减少药物缺货的可能性。
To evaluate the type and frequency of antiretroviral drug stock-outs, and their impact on death and interruption in care among HIV-infected patients in Abidjan, Côte d'Ivoire. We conducted a cohort study of patients who initiated combination antiretroviral therapy (cART) in three adult HIV clinics between February 1, 2006 and June 1, 2007. Follow-up ended on February 1, 2008. The primary outcome was cART regimen modification, defined as at least one drug substitution, or discontinuation for at least one month due to drug stock-outs at the clinic pharmacy. The secondary outcome for patients who were on cART for at least six months was interruption in care, or death. A Cox regression model with time-dependent variables was used to assess the impact of antiretroviral drug stock-outs on interruption in care or death. Overall, 1,554 adults initiated cART and were followed for a mean of 13.2 months. During this time, 72 patients discontinued treatment and 98 modified their regimen because of drug stock-outs. Stock-outs involved nevirapine and fixed-dose combination zidovudine/lamivudine in 27% and 51% of cases. Of 1,554 patients, 839 (54%) initiated cART with fixed-dose stavudine/lamivudine/nevirapine and did not face stock-outs during the study period. Among the 975 patients who were on cART for at least six months, stock-out-related cART discontinuations increased the risk of interruption in care or death (adjusted hazard ratio [HR], 2.83; 95%CI, 1.25–6.44) but cART modifications did not (adjusted HR, 1.21; 95%CI, 0.46–3.16). cART stock-outs affected at least 11% of population on treatment. Treatment discontinuations due to stock-outs were frequent and doubled the risk of interruption in care or death. These stock-outs did not involve the most common first-line regimen. As access to cART continues to increase in sub-Saharan Africa, first-line regimens should be standardized to decrease the probability of drug stock-outs.
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DOI：
10.2471/blt.06.032060
发表时间：
2007-02-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Harries, Anthony D;Schouten, Erik J;Lungu, Douglas
通讯作者：
Lungu, Douglas
DOI：
10.1097/00042560-200205010-00014
发表时间：
2002-05-01
期刊：
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
影响因子：
--
作者：
de Olalla, PG;Knobel, H;Caylà, JA
通讯作者：
Caylà, JA
DOI：
10.2471/blt.07.044248
发表时间：
2008-07-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Brinkhof, Martin WG;Dabis, François;Anglaret, Xavier
通讯作者：
Anglaret, Xavier
影响因子：
3
作者：
Fischer, A;Karasi, JC;Arendt, V
通讯作者：
Arendt, V
影响因子：
3.8
作者：
Messou, Eugene;Anglaret, Xavier;Seyler, Catherine
通讯作者：
Seyler, Catherine