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Ochieng W, Kitawi RC, Nzomo TJ, Mwatelah RS, Kimulwo MJ, Ochieng DJ, Kinyua J, Lagat N, Onyango KO, Lwembe RM, Mwamburi M, Ogutu BR, Oloo FA, Aman R. Implementation and Operational Research: Correlates of Adherence and Treatment Failure Among Kenyan Patients on Long-term Highly Active Antiretroviral Therapy. J Acquir Immune Defic Syndr 2015; 69:e49-56. [PMID: 26009836 PMCID: PMC4445604 DOI: 10.1097/qai.0000000000000580] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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 viral load (VL) could define treatment failure in a resource-limited setting. METHODS A multicenter longitudinal and cross-sectional survey of VL, CD4 T cells, and adherence in 546 patients receiving HAART for up to 228 months. VL and CD4 counts were determined using m2000 Abbott RealTime HIV-1 assay and FACS counters, respectively. Adherence was assessed based on pill count and on self-report. RESULTS Of the patients, 55.8%, 22.2%, and 22% had good, fair, and poor adherence, respectively. Adherence, peer support, and regimen, but not HIV disclosure, age, or gender, independently correlated with VL and durability of treatment in a multivariate analysis (P < 0.001). Treatment failure was 35.9% using sequential VL but ranged between 27% and 35% using alternate single VL cross-sectional definitions. More patients failed stavudine (41.2%) than zidovudine (37.4%) or tenofovir (28.8%, P = 0.043) treatment arms. Peer support correlated positively with adherence (χ(2), P < 0.001), with nonadherence being highest in the stavudine arm. VL before the time of regimen switch was comparable between patients switching and not switching treatment. Moreover, 36% of those switching still failed the second-line regimen. CONCLUSION Weak adherence support and inaccessible VL testing threaten to compromise the success of HAART scale-up in Kenya. To hasten antiretroviral therapy monitoring and decision making, we suggest strengthening patient-focused adherence programs, optimizing and aligning regimen to WHO standards, and a single point-of-care VL testing when multiple tests are unavailable.
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Affiliation(s)
- Washingtone Ochieng
- *Center for Research in Therapeutic Sciences and the Institute of Healthcare Management, Strathmore University, Nairobi, Kenya; †Kenya Medical Research Institute, Nairobi, Kenya; ‡Institute of Tropical Medicine and Infectious Diseases at JKUAT, Nairobi, Kenya; §MCPHS University, Worcester, MA; ‖Center for Global Public Health, Tufts University School of Medicine, Boston, MA; and ¶African Centre for Clinical Trials, Nairobi, Kenya
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Nzomo TJ, Kitawi RC, Mwatelah RS, Aman R, Kimulwo MJ, Masankwa G, Okendo J, Lwembe RM, Ogutu B, Muigai A, Ochieng W. Genotypic Variability of HIV-1 Reverse Transcriptase Gene from Long-Term Antiretroviral-Experienced Patients in Kenya. AIDS Res Hum Retroviruses 2015; 31:550-3. [PMID: 25748548 DOI: 10.1089/aid.2015.0031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There is continuous need to track genetic profiles of HIV strains circulating in different geographic settings to hasten vaccine discovery and inform public health and intervention policies. We partially sequenced the reverse transcriptase region of the HIV-1 pol gene from a total of 54 Kenyan patients aged 18-56 years who continued highly active antiretroviral treatment (HAART) for between 8 and 102 months. Subtyping was done using both the JPHMM tool and phylogenetic method. HIV-1 subtype A1 was the predominant strain in circulation, representing 57.4% and 70.4% of all isolates as determined by JPHMM and phylogenetic methods, respectively. Subtypes D (14.8%, 7.4%), C (5.6%, 9.3%), and A2 (0%, 5.6%) were determined at respective prevalence by both methods. JPHMM identified 22.2% of the isolates as recombinants. This surveillance focused on the RT gene and reaffirms the predominance of subtype A and an increasing proportion of recombinant strains in the Kenyan epidemic.
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Affiliation(s)
- Timothy J. Nzomo
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- Institute of Tropical Medicine and Infectious Diseases, Nairobi, Kenya
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Rose C. Kitawi
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- Institute of Tropical Medicine and Infectious Diseases, Nairobi, Kenya
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Ruth S. Mwatelah
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- Institute of Tropical Medicine and Infectious Diseases, Nairobi, Kenya
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Rashid Aman
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- African Center for Clinical Trials, Nairobi, Kenya
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
| | - Maureen J. Kimulwo
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- Institute of Tropical Medicine and Infectious Diseases, Nairobi, Kenya
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Geoffrey Masankwa
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | | | - Bernhards Ogutu
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Anne Muigai
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Washingtone Ochieng
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
- Kenya Medical Research Institute, Nairobi, Kenya
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
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Ochieng W, Kitawi RC, Nzomo TJ, Mwatelah RS, Hungu C, Kimulwo MJ, Onyango KO, Lwembe RM, Mwamburi M, Ogutu BR, Oloo FA, Aman R. Correlates of Adherence and Antiretroviral Treatment Failure in HIV-1 Infected Kenyan Patients. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5347.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Washingtone Ochieng
- Center for Research in Therapeutic Sciences, Nairobi, Kenya
- Kenya Medical Research Institute, Centre for Virus Research, Nairobi, Kenya
| | - Rose C. Kitawi
- Center for Research in Therapeutic Sciences, Nairobi, Kenya
- Institute of Tropical Medicine and Infectious Diseases, Nairobi, Kenya
| | - Timothy J. Nzomo
- Center for Research in Therapeutic Sciences, Nairobi, Kenya
- Institute of Tropical Medicine and Infectious Diseases, Nairobi, Kenya
| | - Ruth S. Mwatelah
- Center for Research in Therapeutic Sciences, Nairobi, Kenya
- Institute of Tropical Medicine and Infectious Diseases, Nairobi, Kenya
| | - Charity Hungu
- Kenya Medical Research Institute, Centre for Virus Research, Nairobi, Kenya
| | - Maureen J. Kimulwo
- Center for Research in Therapeutic Sciences, Nairobi, Kenya
- Institute of Tropical Medicine and Infectious Diseases, Nairobi, Kenya
| | - Kevin O. Onyango
- Center for Research in Therapeutic Sciences, Nairobi, Kenya
- Novartis Vaccines and Diagnostics Inc., Cambridge, MA, United States
| | - Raphael M. Lwembe
- Kenya Medical Research Institute, Centre for Virus Research, Nairobi, Kenya
| | - Mkaya Mwamburi
- Tufts University School of Medicine, Center for Global Public Health, Boston, MA, United States
| | - Berhnards R. Ogutu
- Center for Research in Therapeutic Sciences, Nairobi, Kenya
- Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya
| | - Florence A. Oloo
- Center for Research in Therapeutic Sciences, Nairobi, Kenya
- Kenya Technical University, Nairobi, Kenya
| | - Rashid Aman
- Center for Research in Therapeutic Sciences, Nairobi, Kenya
- African Centre for Clinical Trials, Nairobi, Kenya
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