Ndege Robert C, Okuma James, Kalinjuma Aneth V, Mkumbo Julius, Senkoro Elizabeth, Fue Gideon, Samson Leila, Mapesi Herry, Shabani Siraji, Glass Tracy R, Battegay Manuel, Paris Daniel H, Vanobberghen Fiona, Weisser Maja
Ifakara Health Institute, Ifakara Branch, Ifakara, Tanzania.
St. Francis Referral Hospital, Ifakara, Tanzania.
HIV Med. 2022 Jul;23(6):661-672. doi: 10.1111/hiv.13223. Epub 2021 Dec 28.
Pill count is used to assess drug adherence in people living with HIV (PLHIV). Carrying a pillbox is associated with fear of concealment and stigma and might indicate poor adherence and predict someone who will be lost to follow-up (LTFU). We therefore assessed the association between pillbox return and being LTFU in rural Tanzania.
This is a nested study of the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO). We included PLHIV aged ≥ 18 years enrolled in KIULARCO between January 2013 and March 2019 with follow-up through January 2020, who were on antiretroviral treatment (ART) for ≥ 6 months. Baseline was defined as the latest ART initiation or KIULARCO enrolment. We determined the association between time-dependent failed pillbox return updated at every visit and LTFU using Kaplan-Meier estimation and Cox models.
Among 2552 PLHIV included in the study, 1735 (68.0%) were female, 959 (40.3%) had a WHO stage III/IV and 1487 (66.4%) had a CD4 cell count < 350 cells/µL. The median age was 38.4 years [interquartile range (IQR): 31.7-46.2]. During a median follow-up of 33.1 months (IQR: 17.5-52.4), 909 (35.6%) participants were LTFU, 43 (1.7%) died and 194 (7.6%) had transferred to another clinic. The probability of being LTFU was higher among PLHIV with failed pillbox return than among those who returned their pillbox [30.0%, 95% confidence interval (CI): 26.8-33.2% vs. 19.4%, 95% CI: 17.4-21.6%, respectively, at 24 months (hazard ratio = 1.67, 95% CI: 1.46-1.90; p < 0.001)].
Failed pillbox return was associated with a higher risk of being LTFU and could be used as a simple tool to identify PLHIV for appropriate interventions to reduce their chance of being LTFU.
药丸计数用于评估艾滋病毒感染者（PLHIV）的药物依从性。携带药盒与担心被隐瞒和污名化有关，可能表明依从性差，并可预测失访（LTFU）者。因此，我们评估了在坦桑尼亚农村药盒归还与失访之间的关联。
这是一项对基洛梅罗和乌朗加抗逆转录病毒队列（KIULARCO）的嵌套研究。我们纳入了2013年1月至2019年3月期间在KIULARCO登记、年龄≥18岁、接受抗逆转录病毒治疗（ART）≥6个月且随访至2020年1月的PLHIV。基线定义为最近一次开始ART治疗或加入KIULARCO的时间。我们使用Kaplan-Meier估计法和Cox模型确定每次就诊时更新的时间依赖性药盒归还失败与失访之间的关联。
在纳入研究的2552名PLHIV中，1735名（68.0%）为女性，959名（40.3%）处于世界卫生组织III/IV期，1487名（66.4%）的CD4细胞计数<350个/µL。中位年龄为38.4岁[四分位间距（IQR）：31.7 - 46.2]。在中位随访33.1个月（IQR：17.5 - 52.4）期间，909名（35.6%）参与者失访，43名（1.7%）死亡，194名（7.6%）转至另一家诊所。药盒归还失败的PLHIV失访概率高于归还药盒的PLHIV[24个月时分别为30.0%，95%置信区间（CI）：26.8 - 33.2%与19.4%，95%CI：17.4 - 21.6%，风险比 = 1.67，95%CI：1.46 - 1.90；p < 0.001]。
药盒归还失败与失访风险较高相关，可作为一种简单工具来识别PLHIV，以便采取适当干预措施降低其失访几率。
