TY - JOUR
T1 - Antiretroviral therapy uptake and predictors of virological failure in patients with HIV receiving first-line and second-line regimens in Johannesburg, South Africa
T2 - A retrospective cohort data analysis
AU - Gumede, Siphamandla Bonga
AU - Venter, Francois
AU - De Wit, John
AU - Wensing, Annemarie
AU - Lalla-Edward, Samanta Tresha
N1 - Funding Information:
Funding This study was funded by the Department of Interdisciplinary Social Science at Utrecht University (no award/grant number received) as part of the joint doctorate programme between Utrecht University and University of the Witwatersrand. SBG was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Carnegie Corporation of New York (Grant No—G-19-57145), Sida (Grant No:54100113), Uppsala Monitoring Centre and the DELTAS Africa Initiative (Grant No: 107768/Z/15/Z). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (UK) and the UK government. The statements made and views expressed are solely the responsibility of the Fellow. Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number UG3HL156388. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.
PY - 2022/4/15
Y1 - 2022/4/15
N2 - Objective This study described the demographics, treatment information and identified characteristics associated with virological failure and being lost to follow-up (LTFU) for patients with HIV on first-line and second-line antiretroviral therapy (ART) regimens in a large South African cohort. Design A quantitative retrospective cohort study using secondary data analysis. Setting Seven Johannesburg inner city facilities. Participants Unique records of 123 002 people with HIV receiving ART at any point in the period 1 April 2004 to 29 February 2020 were included. Measures Demographic characteristics, ART status, CD4 count information and retention status were collected and analysed as covariates of outcomes (viral load (VL) and LTFU). Results Of the total study patients, 95% (n=1 17 260) were on a first-line regimen and 5% (n=5742) were on a second-line regimen. Almost two-thirds were female (64%, n=79 226). Most patients (60%, n=72 430) were initiated on an efavirenz-based, tenofovir disoproxil fumarate-based and emtricitabine-based regimen (fixed-dose combination). 91% (n=76 737) achieved viral suppression at least once since initiating on ART and 60% (n=57 981) remained in care as at the end of February 2020. Patients from the community health centre and primary healthcare clinics were not only more likely to be virally suppressed but also more likely to be LTFU. Patients on second-line regimens were less likely to reach viral suppression (adjusted OR (aOR)=0.26, CI=0.23 to 0.28) and more likely to be LTFU (aOR=1.21, CI=1.09 to 1.35). Being older (≥25 years) and having a recent CD4 cell count≥100 cells/μL were predictors of viral suppression and retention in patients on ART. Conclusion Patients on first-line regimens had higher VL suppression rates and were more likely to remain in care than those on a second-line regimen. Being younger and having low CD4 cell counts were associated with poor outcomes, suggesting priority groups for ART adherence support.
AB - Objective This study described the demographics, treatment information and identified characteristics associated with virological failure and being lost to follow-up (LTFU) for patients with HIV on first-line and second-line antiretroviral therapy (ART) regimens in a large South African cohort. Design A quantitative retrospective cohort study using secondary data analysis. Setting Seven Johannesburg inner city facilities. Participants Unique records of 123 002 people with HIV receiving ART at any point in the period 1 April 2004 to 29 February 2020 were included. Measures Demographic characteristics, ART status, CD4 count information and retention status were collected and analysed as covariates of outcomes (viral load (VL) and LTFU). Results Of the total study patients, 95% (n=1 17 260) were on a first-line regimen and 5% (n=5742) were on a second-line regimen. Almost two-thirds were female (64%, n=79 226). Most patients (60%, n=72 430) were initiated on an efavirenz-based, tenofovir disoproxil fumarate-based and emtricitabine-based regimen (fixed-dose combination). 91% (n=76 737) achieved viral suppression at least once since initiating on ART and 60% (n=57 981) remained in care as at the end of February 2020. Patients from the community health centre and primary healthcare clinics were not only more likely to be virally suppressed but also more likely to be LTFU. Patients on second-line regimens were less likely to reach viral suppression (adjusted OR (aOR)=0.26, CI=0.23 to 0.28) and more likely to be LTFU (aOR=1.21, CI=1.09 to 1.35). Being older (≥25 years) and having a recent CD4 cell count≥100 cells/μL were predictors of viral suppression and retention in patients on ART. Conclusion Patients on first-line regimens had higher VL suppression rates and were more likely to remain in care than those on a second-line regimen. Being younger and having low CD4 cell counts were associated with poor outcomes, suggesting priority groups for ART adherence support.
KW - HIV & AIDS
KW - PRIMARY CARE
KW - Public health
KW - Humans
KW - Anti-HIV Agents/therapeutic use
KW - Male
KW - CD4 Lymphocyte Count
KW - Viral Load
KW - HIV Infections/drug therapy
KW - Data Analysis
KW - Female
KW - South Africa
KW - Retrospective Studies
KW - Cohort Studies
UR - http://www.scopus.com/inward/record.url?scp=85128487571&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2021-054019
DO - 10.1136/bmjopen-2021-054019
M3 - Article
C2 - 35428623
AN - SCOPUS:85128487571
SN - 2044-6055
VL - 12
JO - BMJ Open
JF - BMJ Open
IS - 4
M1 - e054019
ER -