Adherence to highly active antiretroviral therapy assessed by pharmacy claims predicts survival in HIV-infected South African adults

Jean B. Nachega, Michael Hislop, David W. Dowdy, Melanie Lo, Saad B. Omer, Leon Regensberg, Richard E. Chaisson, Gary Maartens

Research output: Contribution to journalArticlepeer-review

Abstract

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, 3805 (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-up 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 ≤50 cells/μL vs >200 cells/μL). Pharmacy-based records may be a simple and effective population-level tool for monitoring adherence as HAART programs in Africa are scaled up.

Original languageEnglish (US)
Pages (from-to)78-84
Number of pages7
JournalJournal of acquired immune deficiency syndromes
Volume43
Issue number1
DOIs
StatePublished - Sep 2006

Keywords

  • Adherence
  • HAART
  • HIV
  • Pharmacy claims
  • South Africa
  • Survival

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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