Implementation and Operational Research: Correlates of Adherence and Treatment Failure Among Kenyan XXXX on Long-term Highly Active Antiretroviral Therapy.

@entity1 @entity9611 @entity404 @entity14027 @entity2858 @entity645 @entity1800 @entity15833
BACKGROUND: Universal access to highly active antiretroviral therapy (HAART) is still elusive in most developing nations. We asked whether peer support influenced adherence and treatment outcome and if a single @entity1800 ( @entity1800 ) could define treatment failure in a resource-limited setting. METHODS: A multicenter longitudinal and cross-sectional survey of @entity1800 , @entity404 T cells, and adherence in 546 @entity1 receiving HAART for up to 228 months. @entity1800 and @entity404 counts were determined using m2000 Abbott RealTime @entity2858 assay and FACS counters, respectively. Adherence was assessed based on pill count and on self-report. RESULTS: Of the @entity1 , 55.8%, 22.2%, and 22% had good, fair, and poor adherence, respectively. Adherence, peer support, and regimen, but not @entity645 disclosure, age, or gender, independently correlated with @entity1800 and durability of treatment in a multivariate analysis (P < 0.001). Treatment failure was 35.9% using sequential @entity1800 but ranged between 27% and 35% using alternate single @entity1800 cross-sectional definitions. More @entity1 failed @entity14027 (41.2%) than @entity9611 (37.4%) or @entity15833 (28.8%, P = 0.043) treatment arms. Peer support correlated positively with adherence (  (2), P < 0.001), with nonadherence being highest in the @entity14027 arm. @entity1800 before the time of regimen switch was comparable between @entity1 switching and not switching treatment. Moreover, 36% of those switching still failed the second-line regimen. CONCLUSION: Weak adherence support and inaccessible @entity1800 testing threaten to compromise the success of HAART scale-up in Kenya. To hasten antiretroviral therapy monitoring and decision making, we suggest strengthening @entity1 -focused adherence programs, optimizing and aligning regimen to WHO standards, and a single point-of-care @entity1800 testing when multiple tests are unavailable.
