Title |
Impact of Drug Stock-Outs on Death and Retention to Care among HIV-Infected Patients on Combination Antiretroviral Therapy in Abidjan, Côte d'Ivoire
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Published in |
PLOS ONE, October 2010
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DOI | 10.1371/journal.pone.0013414 |
Pubmed ID | |
Authors |
Armelle Pasquet, Eugène Messou, Delphine Gabillard, Albert Minga, Ayeby Depoulosky, Sylvie Deuffic-Burban, Elena Losina, Kenneth A. Freedberg, Christine Danel, Xavier Anglaret, Yazdan Yazdanpanah |
Abstract |
To evaluate the type and frequency of antiretroviral drug stock-outs, and their impact on death and interruption in care among HIV-infected patients in Abidjan, Côte d'Ivoire. We conducted a cohort study of patients who initiated combination antiretroviral therapy (cART) in three adult HIV clinics between February 1, 2006 and June 1, 2007. Follow-up ended on February 1, 2008. The primary outcome was cART regimen modification, defined as at least one drug substitution, or discontinuation for at least one month due to drug stock-outs at the clinic pharmacy. The secondary outcome for patients who were on cART for at least six months was interruption in care, or death. A Cox regression model with time-dependent variables was used to assess the impact of antiretroviral drug stock-outs on interruption in care or death. Overall, 1,554 adults initiated cART and were followed for a mean of 13.2 months. During this time, 72 patients discontinued treatment and 98 modified their regimen because of drug stock-outs. Stock-outs involved nevirapine and fixed-dose combination zidovudine/lamivudine in 27% and 51% of cases. Of 1,554 patients, 839 (54%) initiated cART with fixed-dose stavudine/lamivudine/nevirapine and did not face stock-outs during the study period. Among the 975 patients who were on cART for at least six months, stock-out-related cART discontinuations increased the risk of interruption in care or death (adjusted hazard ratio [HR], 2.83; 95%CI, 1.25-6.44) but cART modifications did not (adjusted HR, 1.21; 95%CI, 0.46-3.16). cART stock-outs affected at least 11% of population on treatment. Treatment discontinuations due to stock-outs were frequent and doubled the risk of interruption in care or death. These stock-outs did not involve the most common first-line regimen. As access to cART continues to increase in sub-Saharan Africa, first-line regimens should be standardized to decrease the probability of drug stock-outs. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 2 | 1% |
United Kingdom | 1 | <1% |
Tanzania, United Republic of | 1 | <1% |
Unknown | 190 | 98% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Master | 39 | 20% |
Researcher | 26 | 13% |
Student > Ph. D. Student | 19 | 10% |
Student > Postgraduate | 16 | 8% |
Other | 12 | 6% |
Other | 37 | 19% |
Unknown | 45 | 23% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 61 | 31% |
Nursing and Health Professions | 14 | 7% |
Social Sciences | 14 | 7% |
Pharmacology, Toxicology and Pharmaceutical Science | 11 | 6% |
Agricultural and Biological Sciences | 7 | 4% |
Other | 33 | 17% |
Unknown | 54 | 28% |