Second-Line Antiretroviral Therapy in a Workplace and Community-Based Treatment Programme in South Africa Determinants of Virological Outcome 英文参考文献.docVIP

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Second-Line Antiretroviral Therapy in a Workplace and Community-Based Treatment Programme in South Africa Determinants of Virological Outcome 英文参考文献.doc

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Second-Line Antiretroviral Therapy in a Workplace and Community-Based Treatment Programme in South Africa Determinants of Virological Outcome 英文参考文献

Second-LineAntiretroviralTherapyinaWorkplaceand Community-BasedTreatmentProgrammeinSouth Africa:DeterminantsofVirologicalOutcome VictoriaJohnston1*,KatherineFielding2,SalomeCharalambous3,MildredMampho3, GavinChurchyard1,3,4,AndrewPhillips5,AlisonD.Grant1 1Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom, 2Department of Infectious Diseases Epidemiology, LondonSchoolofHygieneandTropicalMedicine,London,UnitedKingdom,3DepartmentofResearch,TheAurumInstitute,Johannesburg,SouthAfrica,4Centreforthe AIDSProgrammeofResearchinSouthAfrica,UniversityofKwaZuluNatal,Durban,SouthAfrica, 5DepartmentofInfectionandPopulationHealth,UniversityCollege London,London,UnitedKingdom Abstract Background: As antiretroviral treatment (ART) programmes in resource-limited settings mature, more patients are experiencingvirologicalfailure.Withoutresistancetesting,decidingwhoshouldswitchtosecond-lineARTcanbedifficult. Theconsequencesforsecond-lineoutcomesareunclear.Inaworkplace-andcommunity-basedmulti-siteprogramme,with 6-monthly virological monitoring, we describe outcomes and predictors of viral suppression on second-line, protease inhibitor-basedART. Methods:Weusedprospectivelycollectedclinicdatafrompatientscommencingfirst-lineARTbetween1/1/03and31/12/ 08toconstructastudycohortofpatientsswitchedtosecond-lineARTinthepresenceofaviralload(VL)$400copies/ml. PredictorsofVL,400copies/mlwithin15monthsofswitchwereassessedusingmodifiedPoissonregressiontoestimate riskratios. Results:205workplacepatients(91.7%male;medianage43yrs)and212communitypatients(38.7%male;medianage36 yrs)switchedregimens.Atswitchcomparedtocommunitypatients,workplacepatientshadalongerdurationofviraemia, higherVL,lowerCD4count,andhigherreportednon-adherenceonfirst-lineART.Non-adherencewasthereportedreason forswitching inahigher proportionofworkplace patients.Following switch,48.3%(workplace) and72.0%(community) achievedVL,400,withnon-adherence(17.9%vs.1.4%)andvirologica