Coker Modupe, Etiebet Mary-Ann, Chang Harry, Awwal Gambo, Jumare Jibreel, Musa Baba Maiyaki, Babashani Musa, Habib Abdulrazaq G, Dakum Patrick, Abimiku Alashle G, Charurat Man E, Blattner William A, Eng Maria, Ndembi Nicaise
Institute of Human Virology, Pent House, Maina Court, Plot 252, Herbert Macaulay Way, Central Business District, P.O. Box 9396, Garki, Abuja, Nigeria.
Curr HIV Res. 2015;13(4):279-85. doi: 10.2174/1570162x13666150407143838.
Virological suppression is the main goal of antiretroviral therapy. To achieve this goal, efficient interventions that promote treatment adherence are needed. This study was aimed at exploring the impact of peer-education on virological outcomes in Northern Nigeria.
A randomized controlled trial (RCT) among patients receiving antiretroviral treatment was conducted in 2 phases between August 2006 and January 2008 in the "largely Muslim" Northern Nigeria. Participants were randomized into one of three intervention arms: standard of care arm, a second arm which included daily reminders via alarm and follow-up calls from peer-educators, and adherence support by a home-based treatment partner; and a third arm which included second arm activities, plus home visits by peer-educators. We evaluated sociodemographic factors and adherence levels, measured using self-report and pharmacy (Rx) refill rates, as risk factors for viral load (VL) suppression.
Of the 600 participants (43% males), 276 were observed till the end of the study. There were no significant differences in mean log 10 VL between the intervention groups. At the end of entire follow-up period, 83% (229/276) who were not lost to follow-up achieved undetectable VL (< 400 copies/ml). In the multivariable analysis, age between 30-34 years (vs 18-24 years) and both baseline CD4 ranges between 100-199 cells/mm(3) or 200-349 cells/mm(3) (vs CD4 <100 cells/mm(3)) as positively associated with VL suppression while poor self-reported adherence and <95% Rx refill rates were negatively associated with VL suppression.
High levels of viral suppression and low prevalence of drug resistance mutations (DRMs) were seen in this cohort participating in an ART adherence study in Northern Nigeria. Self-reported good adherence and optimal Rx refill rates were reported as significant predictors of VL suppression. Our findings indicate that ART adherence will improve significantly regardless of whether HIV-infected adults received peer-education-based medication adherence interventions or standard of care services.
病毒学抑制是抗逆转录病毒治疗的主要目标。为实现这一目标，需要有效的干预措施来促进治疗依从性。本研究旨在探讨同伴教育对尼日利亚北部病毒学结果的影响。
2006年8月至2008年1月期间，在“主要为穆斯林”的尼日利亚北部对接受抗逆转录病毒治疗的患者进行了一项随机对照试验（RCT），分两个阶段进行。参与者被随机分为三个干预组之一：标准护理组、第二个组包括通过闹钟每日提醒以及同伴教育者的随访电话，以及由居家治疗伙伴提供的依从性支持；第三个组包括第二个组的活动，外加同伴教育者的家访。我们评估了社会人口学因素和依从性水平，使用自我报告和药房（Rx） refill率进行测量，作为病毒载量（VL）抑制的危险因素。
在600名参与者（43%为男性）中，276人被观察至研究结束。干预组之间的平均log10 VL没有显著差异。在整个随访期结束时，83%（229/276）未失访的参与者实现了不可检测的VL（<400拷贝/毫升）。在多变量分析中，30 - 34岁（与18 - 24岁相比）以及基线CD4范围在100 - 199细胞/mm³或200 - 349细胞/mm³（与CD4<100细胞/mm³相比）与VL抑制呈正相关，而自我报告的依从性差和Rx refill率<95%与VL抑制呈负相关。
在参与尼日利亚北部抗逆转录病毒治疗依从性研究的这个队列中，观察到高水平的病毒抑制和低耐药性突变（DRMs）患病率。自我报告的良好依从性和最佳Rx refill率被报告为VL抑制的重要预测因素。我们的研究结果表明，无论感染HIV的成年人接受基于同伴教育的药物依从性干预还是标准护理服务，抗逆转录病毒治疗的依从性都会显著提高。
