Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
PLoS One. 2012;7(6):e39894. doi: 10.1371/journal.pone.0039894. Epub 2012 Jun 26.
Many guidelines recommend adherence counseling prior to initiating antiretrovirals (ARVs), however the additional benefit of pre-therapy counseling visits on early adherence is not known. We sought to assess for a benefit of adherence counseling visits prior to ARV initiation versus adherence counseling during the early treatment period.
We performed a secondary analysis of data from a prospective cohort of HIV-infected patients in Mbarara, Uganda. Adults were enrolled upon initiation of ARVs. Our primary exposure of interest was ARV adherence counseling prior to initiating therapy (versus concurrent with initiation of therapy). Our outcomes of interest were: 1) average adherence >90% in first three months; 2) absence of treatment interruptions >72 hours in first three months; and 3) Viral load >400 copies/ml at the three month visit. We fit univariable and multivariable regression models, adjusted for predictors of ARV adherence, to estimate the association between additional pre-therapy counseling visits and our outcomes.
300 participants had records of counseling, of whom 231 (77%) completed visits prior to initiation of ARVs and 69 (23%) on or shortly after initiation. Median age was 33, 71% were female, and median CD4 was 133 cell/ml. Median 90-day adherence was 95%. Participants who completed pre-therapy counseling visits had longer delays from ARV eligibility to initiation (median 49 vs 14 days, p<0.01). In multivariable analyses, completing adherence counseling prior to ARV initiation was not associated with average adherence >90% (AOR 0.8, 95%CI 0.4-1.5), absence of treatment gaps (AOR 0.7, 95%CI 0.2-1.9), or HIV viremia (AOR 1.1, 95%CI 0.4-3.1).
Completion of adherence counseling visits prior to ARV therapy was not associated with higher adherence in this cohort of HIV-infected patients in Uganda. Because mortality and loss-to-follow-up remain high in the pre-ARV period, policy makers should reconsider whether counseling can be delivered with ARV initiation, especially in patients with advanced disease.
许多指南建议在开始使用抗逆转录病毒药物（ARV）之前进行依从性咨询，但是预先进行治疗咨询对早期依从性的额外益处尚不清楚。我们旨在评估在开始 ARV 治疗之前进行依从性咨询与在早期治疗期间进行依从性咨询相比是否有益。
我们对乌干达姆巴拉拉 HIV 感染患者前瞻性队列研究的数据进行了二次分析。成年人在开始 ARV 治疗时入组。我们感兴趣的主要暴露因素是在开始治疗之前（而不是与开始治疗同时）进行 ARV 依从性咨询。我们感兴趣的结果包括：1）前三个月平均依从性>90％；2）前三个月无>72 小时的治疗中断；3）三个月时病毒载量>400 拷贝/ml。我们拟合了单变量和多变量回归模型，调整了 ARV 依从性的预测因素，以评估额外的治疗前咨询访问与我们的结果之间的关联。
300 名参与者有咨询记录，其中 231 名（77％）在开始 ARV 治疗之前完成了访问，69 名（23％）在开始或之后不久完成了访问。中位年龄为 33 岁，71％为女性，中位 CD4 为 133 个细胞/ml。中位 90 天依从性为 95％。完成治疗前咨询访问的参与者从 ARV 资格到开始治疗的时间延迟更长（中位数为 49 天与 14 天，p<0.01）。在多变量分析中，在开始 ARV 治疗之前完成依从性咨询与平均依从性>90％（AOR 0.8，95％CI 0.4-1.5），无治疗间隙（AOR 0.7，95％CI 0.2-1.9）或 HIV 病毒血症（AOR 1.1，95％CI 0.4-3.1）无关。
在乌干达的 HIV 感染患者队列中，完成 ARV 治疗前的咨询访问与更高的依从性无关。由于在 ARV 前期间死亡率和失访率仍然很高，政策制定者应重新考虑是否可以在开始 ARV 治疗时提供咨询，尤其是在疾病晚期的患者中。
