PMID- 28225707
OWN - NLM
STAT- MEDLINE
DCOM- 20180102
LR  - 20220330
IS  - 1473-5571 (Electronic)
IS  - 0269-9370 (Linking)
VI  - 31
IP  - 5
DP  - 2017 Mar 13
TI  - Nonadherence to antiretroviral therapy among HIV-infected patients in Zambia is 
      concentrated among a minority of patients and is highly variable across clinics.
PG  - 689-696
LID - 10.1097/QAD.0000000000001347 [doi]
AB  - OBJECTIVES: The distribution of adherence to antiretroviral therapy (ART) can 
      indicates whether barriers are concentrated or more distributed. We quantified 
      the medication possession ratio (MPR) and characterized the distribution of 
      medication nonpossession in a network of clinics in Zambia to identify 'hotspots' 
      and predictors of poorer adherence. METHODS: We analyzed a population of adults 
      on ART for more than 3 months who made at least one clinic visit between 1 
      January 2013 and 28 February 2015. Pharmacy refill and clinical information were 
      obtained through the electronic medical record system used in routine care. We 
      constructed a Lorenz curve to visualize the distribution of poor adherence and 
      used a multilevel logistic regression model to examine factors associated with 
      MPR. RESULTS: Among 131 767 patients in 56 clinics [64% women, median age 34 
      years (interquartile range (IQR) 29-41), median CD4 cell count at ART initiation 
      351 cells/mul (IQR 220-517)], the median MPR was 85.8% (IQR 70.8-96.8). During 
      months 7-12 on ART, 45.6% of patients had 100% MPR and 10.5% accounted for 50% of 
      medication nonpossession. Across clinics, median MPR ranged from 49.1 to 98.5, 
      and clinic accounted for 12% of the variability in adherence after adjusting for 
      individual and clinic-level characteristics. CONCLUSION: A small fraction of 
      patients account for the majority of days of medication nonpossession. Further 
      characterization of these subpopulations is needed to target interventions. 
      Clinic also accounted for much variability in MPR. Health systems interventions 
      targeting clinic 'hot spots' may represent an efficient use of resources to 
      improve ART adherence.
FAU - Czaicki, Nancy L
AU  - Czaicki NL
AD  - aDivision of Epidemiology, School of Public Health, University of California, 
      Berkeley, Berkeley, California, USAbCentre for Infectious Disease Research in 
      Zambia, Lusaka, ZambiacJohns Hopkins University School of Medicine, Baltimore, 
      Maryland, USAdMinistry of Health of Zambia, Lusaka, ZambiaeDivision of HIV/AIDS, 
      Department of Medicine, University of California, San Francisco, San Francisco 
      General Hospital, San Francisco, California, USA.
FAU - Holmes, Charles B
AU  - Holmes CB
FAU - Sikazwe, Izukanji
AU  - Sikazwe I
FAU - Bolton, Carolyn
AU  - Bolton C
FAU - Savory, Theodora
AU  - Savory T
FAU - Wa Mwanza, Mwanza
AU  - Wa Mwanza M
FAU - Moyo, Crispin
AU  - Moyo C
FAU - Padian, Nancy S
AU  - Padian NS
FAU - Geng, Elvin H
AU  - Geng EH
LA  - eng
PT  - Journal Article
PL  - England
TA  - AIDS
JT  - AIDS (London, England)
JID - 8710219
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
MH  - Adult
MH  - Anti-Retroviral Agents/*therapeutic use
MH  - Antiretroviral Therapy, Highly Active/*statistics & numerical data
MH  - Female
MH  - HIV Infections/*drug therapy
MH  - Humans
MH  - Male
MH  - *Medication Adherence
MH  - Zambia
EDAT- 2017/02/23 06:00
MHDA- 2018/01/03 06:00
CRDT- 2017/02/23 06:00
PHST- 2017/02/23 06:00 [entrez]
PHST- 2017/02/23 06:00 [pubmed]
PHST- 2018/01/03 06:00 [medline]
AID - 00002030-201703130-00010 [pii]
AID - 10.1097/QAD.0000000000001347 [doi]
PST - ppublish
SO  - AIDS. 2017 Mar 13;31(5):689-696. doi: 10.1097/QAD.0000000000001347.