high rate of virological re-suppression among patients failing second-line antiretroviral therapy following enhanced adherence support: a model of care in khayelitsha, south africa

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ID: 216882
2013
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Ranked #13 of 77 articles by views in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

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Abstract
Objective. To describe and evaluate the outcomes of a support programme for patients with virological failure while receiving second-line antiretroviral therapy (ART) in South Africa. Method. We described a comprehensive medical and counselling patient support programme for patients receiving secondline ART and with two consecutive viral loads (VLs) >1 000 copies/ml. Patients with >3 months follow-up and at least one VL measurement after inclusion in the programme were eligible for analysis. Results. Of 69 patients enrolled in the programme, 40 had at least one follow-up VL and no known drug resistance at enrolment; 27 (68%) of these re-suppressed while remaining on second-line ART following enhanced adherence support. The majority (18/27; 67%) achieved re-suppression within the first 3 months in the programme. Five patients with diagnosed second-line drug resistance achieved viral re-suppression (<400 copies/ml) after being switched to third-line ART. Seven patients (7/40; 18%) did not achieve viral re-suppression after 9 months in the programme: 6 with known adherence problems (4 without drug resistance on genotype) and 1 with a VL <1 000 copies/ml. Overall, 3 patients (4%) died, 3 (4%) were lost to follow-up and 2 (3%) were transferred out. Conclusion. Our experience from a routine programme demonstrates that with targeted adherence support, the majority of patients who were viraemic while receiving second-line ART returned to an undetectable VL within 3 months. By increasing the time receiving second-line ART and decreasing the need for genotypes and/or third-line ART, this intervention may reduce costs.
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Authors D B Garone, K Conradie, G Patten, M Cornell, W Goemaere, J Kunene, B Kerschberger, N Ford, A Boulle, G van Cutsem
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Journal Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Year 2013
DOI
10.4102/sajhivmed.v14i4.52
URL
https://sajhivmed.org.za/index.php/hivmed/article/view/52
Keywords
failure antiretroviral therapypublic aspects of medicine

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