Adherence to highly active antiretroviral therapy assessed by pharmacy claims predicts survival in HIV-infected South African adults
Adherence to highly active antiretroviral therapy assessed by pharmacy claims predicts survival in HIV-infected South African adults
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DOI：
10.1097/01.qai.0000225015.43266.46
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发表时间：
2006-09-01
影响因子：
3.6
通讯作者：
Maartens, Gary
中科院分区：
文献类型：
--
作者：
Nachega, Jean B.;Hislop, Michael;Maartens, Gary
目前尚不清楚如何最好地在撒哈拉以南非洲的大型艾滋病毒项目中监测遵守高效抗逆转录病毒疗法(HAART)的情况，那里正在扩大该疗法的规模。我们的目标是评估根据药房声称的HAART依从性与登记在私营部门艾滋病管理计划中的感染HIV-1的南非成年人的存活率之间的关联。在1999年1月至2004年8月期间开始HAART的6288名患者中，3805名(61%)是女性，6094名(97%)是非洲黑人。3298例患者(52%)HAART依从性<80%，1916例患者<80%(30%)。女性的依从性显著高于男性(54%比49%，P<；0.001)。随访时间中位数(四分位数范围)为1.8年(1.37-2.5)年。截至2004年9月1日，已有222名患者死亡--粗死亡率为3.5%。在多变量Cox回归模型中，80%的依从性与较低的存活率相关(相对危险度3.23；95%可信区间：2.37-4.39)。当药物依从性被分成5层，每层宽度为20%时，每一层的存活率低于相邻的高粘附性层。在测试的其他变量中，在多变量分析中，只有基线CD_4~(+)T细胞计数与存活率下降显著相关(相对危险度5.13；95%可信区间：3.42~7.72，CD_4~+T细胞计数200个/亩L)。随着非洲HAART计划的扩大，基于药房的记录可能是一种简单而有效的人口水平监测依从性的工具。
It is unclear how adherence to highly active antiretroviral therapy (HAART) may best be monitored in large HIV programs in sub-Saharan Africa where it is being scaled up. We aimed to evaluate the association between HAART adherence, as estimated by pharmacy claims, and survival in HIV-1-infected South African adults enrolled in a private-sector AIDS management program. Of the 6288 patients who began HAART between January 1999 and August 2004, 3 805 (61%) were female and 6094 (97%) were black African. HAART adherence was >= 80 for 3298 patients (52%) and 100% for 1916 patients (30%). Women were significantly more likely to have adherence >= 80% than men (54% vs 49%, P < 0.001). The median (interquartile range) follow-tip time was 1.8 (1.37-2.5) years. As of 1 September 2004, 222 patients had died-a crude mortality rate of 3.5%. In a multivariate Cox regression model, adherence < 80% was associated with lower survival (relative hazard 3.23; 95% confidence interval: 2..37-4.39). When medication adherence was divided into 5 strata with a width of 20% each, each stratum had lower survival rates than the adjacent, higher-adherence stratum. Among other variables tested, only baseline CD4(+) T-cell count was significantly associated with decreased survival in multivariate analysis (relative hazard 5.13; 95% confidence interval: 3.42-7.72, for CD4(+) T-cell count 200 cells/mu L). Pharmacy-based records may be a simple and effective population-level tool for monitoring adherence as HAART programs in Africa are scaled up.