Medication Possession Ratio Predicts Antiretroviral Regimens Persistence in Peru
OBJECTIVES: In developing nations, the use of operational parameters (OPs) in the prediction of clinical care represents a missed opportunity to enhance the care process. We modeled the impact of multiple measurements of antiretroviral treatment (ART) adherence on antiretroviral treatment outcomes i...
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2013
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| author | Jorge Salinas Jorge Alave Andrew O. Westfall Jorge Paz Fiorella Moran Danny Carbajal-Gonzalez David Callacondo Odalie Avalos Martín Rodríguez Eduardo Gotuzzo Juan Echevarría James H. Willig |
| author_browse | Andrew O. Westfall Danny Carbajal-Gonzalez David Callacondo Eduardo Gotuzzo Fiorella Moran James H. Willig Jorge Alave Jorge Paz Jorge Salinas Juan Echevarría Martín Rodríguez Odalie Avalos |
| author_facet | Jorge Salinas Jorge Alave Andrew O. Westfall Jorge Paz Fiorella Moran Danny Carbajal-Gonzalez David Callacondo Odalie Avalos Martín Rodríguez Eduardo Gotuzzo Juan Echevarría James H. Willig |
| author_sort | Jorge Salinas |
| collection | Producción científica |
| description | OBJECTIVES: In developing nations, the use of operational parameters (OPs) in the prediction of clinical care represents a missed opportunity to enhance the care process. We modeled the impact of multiple measurements of antiretroviral treatment (ART) adherence on antiretroviral treatment outcomes in Peru. DESIGN AND METHODS: Retrospective cohort study including ART naïve, non-pregnant, adults initiating therapy at Hospital Nacional Cayetano Heredia, Lima-Peru (2006-2010). Three OPs were defined: 1) Medication possession ratio (MPR): days with antiretrovirals dispensed/days on first-line therapy; 2) Laboratory monitory constancy (LMC): proportion of 6 months intervals with ≥1 viral load or CD4 reported; 3) Clinic visit constancy (CVC): proportion of 6 months intervals with ≥1 clinic visit. Three multi-variable Cox proportional hazard (PH) models (one per OP) were fit for (1) time of first-line ART persistence and (2) time to second-line virologic failure. All models were adjusted for socio-demographic, clinical and laboratory variables. RESULTS: 856 patients were included in first-line persistence analyses, median age was 35.6 years [29.4-42.9] and most were male (624; 73%). In multivariable PH models, MPR (per 10% increase HR=0.66; 95%CI=0.61-0.71) and LMC (per 10% increase 0.83; 0.71-0.96) were associated with prolonged time on first-line therapies. Among 79 individuals included in time to second-line virologic failure analyses, MPR was the only OP independently associated with prolonged time to second-line virologic failure (per 10% increase 0.88; 0.77-0.99). CONCLUSIONS: The capture and utilization of program level parameters such as MPR can provide valuable insight into patient-level treatment outcomes. |
| format | Article |
| id | oai:cris.upeu.edu.pe:20.500.15037/666 |
| institution | UPeU |
| language | English |
| publishDate | 2013 |
| publishDateRange | 2013 |
| publishDateSort | 2013 |
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| spelling | oai:cris.upeu.edu.pe:20.500.15037/6662026-10-30T16:14:45ZMedication Possession Ratio Predicts Antiretroviral Regimens Persistence in PeruJorge SalinasJorge AlaveAndrew O. WestfallJorge PazFiorella MoranDanny Carbajal-GonzalezDavid CallacondoOdalie AvalosMartín RodríguezEduardo GotuzzoJuan EchevarríaJames H. WilligPersistence (discontinuity)Antiretroviral therapyMedicineInternal medicineDemographyHuman immunodeficiency virus (HIV)VirologyViral loadSociologyGeotechnical engineeringEngineeringPersistence (discontinuity)Antiretroviral therapyMedicineInternal medicineDemographyHuman immunodeficiency virus (HIV)VirologyViral loadAdultAdultAdultDelivery of Health Care statistics & numerical dataDelivery of Health Care statistics & numerical dataDelivery of Health Care statistics & numerical dataFemaleFemaleFemaleHumansHumansHumansMaleMaleMalePeru epidemiologyPeru epidemiologyPeru epidemiologyRetrospective StudiesRetrospective StudiesRetrospective StudiesRisk FactorsRisk FactorsRisk FactorsHIV-1HIV-1HIV-1HIV Infections drug therapyHIV Infections drug therapyHIV Infections drug therapyHIV Infections epidemiologyHIV Infections epidemiologyHIV Infections epidemiologyHIV Infections virologyHIV Infections virologyHIV Infections virologyOutcome Assessment, Health CareOutcome Assessment, Health CareOutcome Assessment, Health CareTreatment FailureTreatment FailureTreatment FailureAntiretroviral Therapy, Highly ActiveAntiretroviral Therapy, Highly ActiveAntiretroviral Therapy, Highly ActiveHealth Sciences Medicine Infectious Diseases HIV/AIDS Research and InterventionsHealth Sciences Medicine Infectious Diseases HIV/AIDS drug development and treatmentHealth Sciences Medicine Emergency Medicine HIV-related health complications and treatmentsOBJECTIVES: In developing nations, the use of operational parameters (OPs) in the prediction of clinical care represents a missed opportunity to enhance the care process. We modeled the impact of multiple measurements of antiretroviral treatment (ART) adherence on antiretroviral treatment outcomes in Peru. DESIGN AND METHODS: Retrospective cohort study including ART naïve, non-pregnant, adults initiating therapy at Hospital Nacional Cayetano Heredia, Lima-Peru (2006-2010). Three OPs were defined: 1) Medication possession ratio (MPR): days with antiretrovirals dispensed/days on first-line therapy; 2) Laboratory monitory constancy (LMC): proportion of 6 months intervals with ≥1 viral load or CD4 reported; 3) Clinic visit constancy (CVC): proportion of 6 months intervals with ≥1 clinic visit. Three multi-variable Cox proportional hazard (PH) models (one per OP) were fit for (1) time of first-line ART persistence and (2) time to second-line virologic failure. All models were adjusted for socio-demographic, clinical and laboratory variables. RESULTS: 856 patients were included in first-line persistence analyses, median age was 35.6 years [29.4-42.9] and most were male (624; 73%). In multivariable PH models, MPR (per 10% increase HR=0.66; 95%CI=0.61-0.71) and LMC (per 10% increase 0.83; 0.71-0.96) were associated with prolonged time on first-line therapies. Among 79 individuals included in time to second-line virologic failure analyses, MPR was the only OP independently associated with prolonged time to second-line virologic failure (per 10% increase 0.88; 0.77-0.99). CONCLUSIONS: The capture and utilization of program level parameters such as MPR can provide valuable insight into patient-level treatment outcomes.Articlehttps://pubmed.ncbi.nlm.nih.gov/24098475https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0076323&type=printablehttps://doi.org/10.1371/journal.pone.007632310.1371/journal.pone.0076323https://hdl.handle.net/20.500.15037/666W2033994684enPLoS ONE1932-62032013-10-012026-06-13T09:30:09Z2026-06-13T09:30:09Z |
| spellingShingle | Persistence (discontinuity) Antiretroviral therapy Medicine Internal medicine Demography Human immunodeficiency virus (HIV) Virology Viral load Sociology Geotechnical engineering Engineering Persistence (discontinuity) Antiretroviral therapy Medicine Internal medicine Demography Human immunodeficiency virus (HIV) Virology Viral load Adult Adult Adult Delivery of Health Care statistics & numerical data Delivery of Health Care statistics & numerical data Delivery of Health Care statistics & numerical data Female Female Female Humans Humans Humans Male Male Male Peru epidemiology Peru epidemiology Peru epidemiology Retrospective Studies Retrospective Studies Retrospective Studies Risk Factors Risk Factors Risk Factors HIV-1 HIV-1 HIV-1 HIV Infections drug therapy HIV Infections drug therapy HIV Infections drug therapy HIV Infections epidemiology HIV Infections epidemiology HIV Infections epidemiology HIV Infections virology HIV Infections virology HIV Infections virology Outcome Assessment, Health Care Outcome Assessment, Health Care Outcome Assessment, Health Care Treatment Failure Treatment Failure Treatment Failure Antiretroviral Therapy, Highly Active Antiretroviral Therapy, Highly Active Antiretroviral Therapy, Highly Active Health Sciences Medicine Infectious Diseases HIV/AIDS Research and Interventions Health Sciences Medicine Infectious Diseases HIV/AIDS drug development and treatment Health Sciences Medicine Emergency Medicine HIV-related health complications and treatments Jorge Salinas Jorge Alave Andrew O. Westfall Jorge Paz Fiorella Moran Danny Carbajal-Gonzalez David Callacondo Odalie Avalos Martín Rodríguez Eduardo Gotuzzo Juan Echevarría James H. Willig Medication Possession Ratio Predicts Antiretroviral Regimens Persistence in Peru |
| title | Medication Possession Ratio Predicts Antiretroviral Regimens Persistence in Peru |
| title_full | Medication Possession Ratio Predicts Antiretroviral Regimens Persistence in Peru |
| title_fullStr | Medication Possession Ratio Predicts Antiretroviral Regimens Persistence in Peru |
| title_full_unstemmed | Medication Possession Ratio Predicts Antiretroviral Regimens Persistence in Peru |
| title_short | Medication Possession Ratio Predicts Antiretroviral Regimens Persistence in Peru |
| title_sort | medication possession ratio predicts antiretroviral regimens persistence in peru |
| topic | Persistence (discontinuity) Antiretroviral therapy Medicine Internal medicine Demography Human immunodeficiency virus (HIV) Virology Viral load Sociology Geotechnical engineering Engineering Persistence (discontinuity) Antiretroviral therapy Medicine Internal medicine Demography Human immunodeficiency virus (HIV) Virology Viral load Adult Adult Adult Delivery of Health Care statistics & numerical data Delivery of Health Care statistics & numerical data Delivery of Health Care statistics & numerical data Female Female Female Humans Humans Humans Male Male Male Peru epidemiology Peru epidemiology Peru epidemiology Retrospective Studies Retrospective Studies Retrospective Studies Risk Factors Risk Factors Risk Factors HIV-1 HIV-1 HIV-1 HIV Infections drug therapy HIV Infections drug therapy HIV Infections drug therapy HIV Infections epidemiology HIV Infections epidemiology HIV Infections epidemiology HIV Infections virology HIV Infections virology HIV Infections virology Outcome Assessment, Health Care Outcome Assessment, Health Care Outcome Assessment, Health Care Treatment Failure Treatment Failure Treatment Failure Antiretroviral Therapy, Highly Active Antiretroviral Therapy, Highly Active Antiretroviral Therapy, Highly Active Health Sciences Medicine Infectious Diseases HIV/AIDS Research and Interventions Health Sciences Medicine Infectious Diseases HIV/AIDS drug development and treatment Health Sciences Medicine Emergency Medicine HIV-related health complications and treatments |
| topic_facet | Persistence (discontinuity) Antiretroviral therapy Medicine Internal medicine Demography Human immunodeficiency virus (HIV) Virology Viral load Sociology Geotechnical engineering Engineering Persistence (discontinuity) Antiretroviral therapy Medicine Internal medicine Demography Human immunodeficiency virus (HIV) Virology Viral load Adult Adult Adult Delivery of Health Care statistics & numerical data Delivery of Health Care statistics & numerical data Delivery of Health Care statistics & numerical data Female Female Female Humans Humans Humans Male Male Male Peru epidemiology Peru epidemiology Peru epidemiology Retrospective Studies Retrospective Studies Retrospective Studies Risk Factors Risk Factors Risk Factors HIV-1 HIV-1 HIV-1 HIV Infections drug therapy HIV Infections drug therapy HIV Infections drug therapy HIV Infections epidemiology HIV Infections epidemiology HIV Infections epidemiology HIV Infections virology HIV Infections virology HIV Infections virology Outcome Assessment, Health Care Outcome Assessment, Health Care Outcome Assessment, Health Care Treatment Failure Treatment Failure Treatment Failure Antiretroviral Therapy, Highly Active Antiretroviral Therapy, Highly Active Antiretroviral Therapy, Highly Active Health Sciences Medicine Infectious Diseases HIV/AIDS Research and Interventions Health Sciences Medicine Infectious Diseases HIV/AIDS drug development and treatment Health Sciences Medicine Emergency Medicine HIV-related health complications and treatments |
| url | https://pubmed.ncbi.nlm.nih.gov/24098475 https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0076323&type=printable https://doi.org/10.1371/journal.pone.0076323 https://hdl.handle.net/20.500.15037/666 |
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