Adherence support improves ART outcomes in Kenya

Michael Carter
Original Article: 

The scale-up of antiretroviral therapy (ART) in Kenya is being undermined by high rates of treatment failure, investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. Over a third of patients failed first- and second-line therapy. Use of inappropriate regimens and lack of adherence support were associated with failure to control viral load.

“We describe factors that influence adherence and virologic failure, and provide evidence to inform treatment decisions under conditions of limiting resources,” comment the authors. “Of the 514 patients…35.9% failed first-line regimen…and 36% failed second-line after switching treatment.”

Access to ART is expanding rapidly in Kenya. Evidence from around the world shows that ART can transform the health and life expectancy of people with HIV. But there is concern that weaknesses in health systems, use of inappropriate regimens and restricted access to viral monitoring are undermining the potential benefits of HIV therapy in Kenya.

Investigators therefore designed a study to determine the proportion of people taking long-term ART who experienced virologic failure with first- and second-line regimens and the impact of factors such as adherence support and viral load monitoring on treatment outcomes.

People aged between 5 and 73 years were recruited at six rural treatment centres and had been taking ART for up to 228 months (median, 48 months). All the facilities provided community peer support programmes run by HIV-positive volunteers to support patients to adhere to their therapy. Treatment failure was defined as viral load persistently above 1000 copies/ml in consecutive viral load tests at least six months apart.

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