Targets for intervention to improve virological outcomes for patients receiving free antiretroviral therapy in Tamil Nadu, India

James Hamilton McMahon, Anand Manoharan, Christine Wanke, Shoba Mammen, Hepsibah Jose, Malini Thabeetha, Tony Kadavanu, Michael R Jordan, Julian Elliott, Sharon Ruth Lewin, Dilip Mathai

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

Abstract

Operational research to identify factors predicting poor clinical outcomes is critical to maximize patient care and prolong first-line regimens for those receiving free antiretroviral therapy (ART) in India. We sought to identify social or clinical factors amenable to intervention that predict virological outcomes after 12 months of ART. We examined a retrospective cohort of consecutive adults initiating free nonnucleoside reverse transcriptase inhibitor-based regimens. Individuals remaining in care 12 months post-ART initiation were tested for HIV viral load and surveyed to identify barriers and facilitators to adherence, and to determine clinic travel times and associated costs. Uni- and multivariate logistic regression identified factors predicting HIV viral load >200 copies/mL after 12 months of ART. Of 230 adults initiating ART, 10% of patients died, 8% transferred out, 5% were lost to follow-up, and 174/230 (76%) completed 12 months of ART, the questionnaire, and viral load testing. HIV viral load was /= 3 hours (OR 3.0, p = 0.02), and alcohol use (OR 4.8, p = 0.03) predicted viral load >200 copies/mL after 12 months of ART. Clinical outcomes following ART are related to programmatic factors such as prolonged travel time and individual factors such as being busy with family or using alcohol. Simple interventions that alter these factors should be evaluated to improve clinical outcomes for populations receiving free ART in similar settings.
Original languageEnglish
Pages (from-to)559-566
Number of pages8
JournalAids Care: Psychological and Socio-Medical Aspects of AIDS/HIV
Volume26
Issue number5
DOIs
Publication statusPublished - 2014

Cite this

McMahon, James Hamilton ; Manoharan, Anand ; Wanke, Christine ; Mammen, Shoba ; Jose, Hepsibah ; Thabeetha, Malini ; Kadavanu, Tony ; Jordan, Michael R ; Elliott, Julian ; Lewin, Sharon Ruth ; Mathai, Dilip. / Targets for intervention to improve virological outcomes for patients receiving free antiretroviral therapy in Tamil Nadu, India. In: Aids Care: Psychological and Socio-Medical Aspects of AIDS/HIV. 2014 ; Vol. 26, No. 5. pp. 559-566.
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abstract = "Operational research to identify factors predicting poor clinical outcomes is critical to maximize patient care and prolong first-line regimens for those receiving free antiretroviral therapy (ART) in India. We sought to identify social or clinical factors amenable to intervention that predict virological outcomes after 12 months of ART. We examined a retrospective cohort of consecutive adults initiating free nonnucleoside reverse transcriptase inhibitor-based regimens. Individuals remaining in care 12 months post-ART initiation were tested for HIV viral load and surveyed to identify barriers and facilitators to adherence, and to determine clinic travel times and associated costs. Uni- and multivariate logistic regression identified factors predicting HIV viral load >200 copies/mL after 12 months of ART. Of 230 adults initiating ART, 10{\%} of patients died, 8{\%} transferred out, 5{\%} were lost to follow-up, and 174/230 (76{\%}) completed 12 months of ART, the questionnaire, and viral load testing. HIV viral load was /= 3 hours (OR 3.0, p = 0.02), and alcohol use (OR 4.8, p = 0.03) predicted viral load >200 copies/mL after 12 months of ART. Clinical outcomes following ART are related to programmatic factors such as prolonged travel time and individual factors such as being busy with family or using alcohol. Simple interventions that alter these factors should be evaluated to improve clinical outcomes for populations receiving free ART in similar settings.",
author = "McMahon, {James Hamilton} and Anand Manoharan and Christine Wanke and Shoba Mammen and Hepsibah Jose and Malini Thabeetha and Tony Kadavanu and Jordan, {Michael R} and Julian Elliott and Lewin, {Sharon Ruth} and Dilip Mathai",
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Targets for intervention to improve virological outcomes for patients receiving free antiretroviral therapy in Tamil Nadu, India. / McMahon, James Hamilton; Manoharan, Anand; Wanke, Christine; Mammen, Shoba; Jose, Hepsibah; Thabeetha, Malini; Kadavanu, Tony; Jordan, Michael R; Elliott, Julian; Lewin, Sharon Ruth; Mathai, Dilip.

In: Aids Care: Psychological and Socio-Medical Aspects of AIDS/HIV, Vol. 26, No. 5, 2014, p. 559-566.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Targets for intervention to improve virological outcomes for patients receiving free antiretroviral therapy in Tamil Nadu, India

AU - McMahon, James Hamilton

AU - Manoharan, Anand

AU - Wanke, Christine

AU - Mammen, Shoba

AU - Jose, Hepsibah

AU - Thabeetha, Malini

AU - Kadavanu, Tony

AU - Jordan, Michael R

AU - Elliott, Julian

AU - Lewin, Sharon Ruth

AU - Mathai, Dilip

N1 - McMahon, James H Manoharan, Anand Wanke, Christine Mammen, Shoba Jose, Hepsibah Malini, Thabeetha Kadavanu, Tony Jordan, Michael R Elliott, Julian H Lewin, Sharon R Mathai, Dilip eng England 2013/10/16 06:00 AIDS Care. 2014 May;26(5):559-66. doi: 10.1080/09540121.2013.845282. Epub 2013 Oct 15.

PY - 2014

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N2 - Operational research to identify factors predicting poor clinical outcomes is critical to maximize patient care and prolong first-line regimens for those receiving free antiretroviral therapy (ART) in India. We sought to identify social or clinical factors amenable to intervention that predict virological outcomes after 12 months of ART. We examined a retrospective cohort of consecutive adults initiating free nonnucleoside reverse transcriptase inhibitor-based regimens. Individuals remaining in care 12 months post-ART initiation were tested for HIV viral load and surveyed to identify barriers and facilitators to adherence, and to determine clinic travel times and associated costs. Uni- and multivariate logistic regression identified factors predicting HIV viral load >200 copies/mL after 12 months of ART. Of 230 adults initiating ART, 10% of patients died, 8% transferred out, 5% were lost to follow-up, and 174/230 (76%) completed 12 months of ART, the questionnaire, and viral load testing. HIV viral load was /= 3 hours (OR 3.0, p = 0.02), and alcohol use (OR 4.8, p = 0.03) predicted viral load >200 copies/mL after 12 months of ART. Clinical outcomes following ART are related to programmatic factors such as prolonged travel time and individual factors such as being busy with family or using alcohol. Simple interventions that alter these factors should be evaluated to improve clinical outcomes for populations receiving free ART in similar settings.

AB - Operational research to identify factors predicting poor clinical outcomes is critical to maximize patient care and prolong first-line regimens for those receiving free antiretroviral therapy (ART) in India. We sought to identify social or clinical factors amenable to intervention that predict virological outcomes after 12 months of ART. We examined a retrospective cohort of consecutive adults initiating free nonnucleoside reverse transcriptase inhibitor-based regimens. Individuals remaining in care 12 months post-ART initiation were tested for HIV viral load and surveyed to identify barriers and facilitators to adherence, and to determine clinic travel times and associated costs. Uni- and multivariate logistic regression identified factors predicting HIV viral load >200 copies/mL after 12 months of ART. Of 230 adults initiating ART, 10% of patients died, 8% transferred out, 5% were lost to follow-up, and 174/230 (76%) completed 12 months of ART, the questionnaire, and viral load testing. HIV viral load was /= 3 hours (OR 3.0, p = 0.02), and alcohol use (OR 4.8, p = 0.03) predicted viral load >200 copies/mL after 12 months of ART. Clinical outcomes following ART are related to programmatic factors such as prolonged travel time and individual factors such as being busy with family or using alcohol. Simple interventions that alter these factors should be evaluated to improve clinical outcomes for populations receiving free ART in similar settings.

UR - http://www.ncbi.nlm.nih.gov/pubmed/24125035

U2 - 10.1080/09540121.2013.845282

DO - 10.1080/09540121.2013.845282

M3 - Article

VL - 26

SP - 559

EP - 566

JO - Aids Care: Psychological and Socio-Medical Aspects of AIDS/HIV

JF - Aids Care: Psychological and Socio-Medical Aspects of AIDS/HIV

SN - 0954-0121

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