Abstract
BackgroundTo 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.Methods and FindingsWe 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).ConclusionscART 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.
Highlights
IntroductionThe World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS (UNAIDS) estimate that in late 2007, 30–36 million people were living with HIV, including 22 million in sub-Saharan Africa and 480,000 in Cote d’Ivoire [1]
As access to combination antiretroviral therapy (cART) continues to increase in sub-Saharan Africa, first-line regimens should be standardized to decrease the probability of drug stock-outs
The World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS (UNAIDS) estimate that in late 2007, 30–36 million people were living with HIV, including 22 million in sub-Saharan Africa and 480,000 in Cote d’Ivoire [1]
Summary
The World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS (UNAIDS) estimate that in late 2007, 30–36 million people were living with HIV, including 22 million in sub-Saharan Africa and 480,000 in Cote d’Ivoire [1]. The dramatic rise in global funding for HIV/AIDS, as well as reduced drug costs, have increased the availability of combination antiretroviral therapy (cART) in sub-Saharan Africa [2,3]. With increased access to cART, drug stock-outs related to insufficient human resources and poor infrastructure have been reported, leading to treatment modifications or discontinuations [5,6,7]. Reported that 10% of interruptions were related to drug stock-outs [7]. The efficacy of cART relies on excellent adherence [8], since cART interruptions are associated with higher rates of drug resistance [9], opportunistic infections, and death [10]. 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, Cote d’Ivoire
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