Routine Antiretroviral Pharmacy Refill Information Can Predict Failure Postpartum in Previously Suppressed South African Women With HIV

Author:

Gawler Nicola1,Reynolds Steven J234,Hsiao Nei-Yuan5,Clarke William2,Maartens Gary6ORCID,Abrams Elaine J7,Myer Landon1,Redd Andrew D238,Phillips Tamsin K1

Affiliation:

1. Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town , Cape Town , South Africa

2. Department of Medicine, Johns Hopkins University , Baltimore, Maryland , USA

3. Division of Intramural Research, NIAID, NIH , Baltimore, Maryland , USA

4. Rakai Health Sciences Program , Entebbe , Uganda

5. Division of Medical Virology, University of Cape Town and National Health Laboratory Service , Cape Town , South Africa

6. Division of Clinical Pharmacology, Department of Medicine, University of Cape Town , Cape Town , South Africa

7. ICAP at Columbia University, Mailman School of Public Health, and Department of Paediatrics, Vagelos College of Physicians & Surgeons, Columbia University , New York, New York , USA

8. Institute of Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town , South Africa

Abstract

Abstract Background Detection of antiretrovirals (ARVs) in biological specimens is a reliable, objective way to measure adherence. However, routine ARV testing is not feasible in many high-burden settings. This study explored if pharmacy data could accurately predict HIV viremia postpartum in previously virally suppressed women. Methods South African women with HIV who initiated antiretroviral therapy (ART) during pregnancy and achieved viral suppression (VS; viral load [VL]≤50 copies/mL) were followed postpartum; during follow-up, plasma VL was measured and ARV adherence self-reported. A portion of samples were tested for the presence of ARV using mass spectrometry. Patient-level routine pharmacy data were used to classify if women should have the drug in hand for the past 7 days before the visit date. Logistic regressions were used to calculate associations between adherence and viral nonsuppression (VNS; VL > 50) or failure (VF; VL > 1000) at the first study visit of women who had ARV measured. Data for all women were examined for associations of self-reported adherence and drug in hand with VS and VF at 2, 6, and 12 months postpartum. Results Women with no ARV detected were significantly more likely to have VNS (odds ratio [OR], 26.4). Having no drug in hand for 7 days was also predictive of VNS in these same women (OR, 7.0) and the full cohort (n = 572) at 3 (OR, 2.9), 6 (OR, 8.7), and 12 months (OR, 14.5). Similar results were seen for VF. Conclusions These data show that routine pharmacy data can act as a highly predictive mechanism for identifying patients at risk of VNS and VF due to nonadherence.

Funder

Division of Intramural Research

VECD Global Health

Office of AIDS Research

Fogarty International Center

National Institute of Mental Health

International AIDS Society

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Oncology

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