@article{fdi:010064751,
  title = {{G}ender differences in adherence and response to antiretroviral treatment in the stratall trial in rural district hospitals in {C}ameroon},
  author = {{B}oull{\'e}, {C}harlotte and {K}ouanfack, {C}. and {L}aborde-{B}alen, {G}. and {B}oyer, {S}. and {A}ghokeng {F}obang, {A}velin and {C}arrieri, {M}. {P}. and {K}aze, {S}. and {D}ontsop, {M}. and {M}ben, {J}. {M}. and {K}oulla-{S}hiro, {S}. and {P}eytavin, {G}. and {S}pire, {B}. and {D}elaporte, {E}ric and {L}aurent, {C}hristian},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground:{E}vidence of gender differences in antiretroviral treatment ({ART}) outcomes in sub-{S}aharan {A}frica is conflicting. {O}ur objective was to assess gender differences in (1) adherence to {ART} and (2) virologic failure, immune reconstitution, mortality, and disease progression adjusting for adherence.{M}ethods:{C}ohort study among 459 {ART}-naive patients followed up 24 months after initiation in 2006-2010 in 9 rural district hospitals. {A}dherence to {ART} was assessed using (1) a validated tool based on multiple patient self-reports and (2) antiretroviral plasma concentrations. {T}he associations between gender and the outcomes were assessed using multivariate mixed models or accelerated time failure models.{R}esults:{O}ne hundred thirty-five patients (29.4%) were men. {A}t baseline, men were older, had higher body mass index and hemoglobin level, and received more frequently efavirenz than women. {G}ender was not associated with self-reported adherence ({P} = 0.872, 0.169, and 0.867 for moderate adherence, low adherence, and treatment interruption, respectively) or with antiretroviral plasma concentrations ({P} = 0.549 for nevirapine/efavirenz). {I}n contrast, male gender was associated with virologic failure [odds ratio: 2.18, 95% confidence interval ({CI}): 1.31 to 3.62, {P} = 0.003], lower immunologic reconstitution (coefficient: -58.7 at month 24, 95% {CI}: -100.8 to -16.6, {P} = 0.006), and faster progression to death (time ratio: 0.30, 95% {CI}: 0.12 to 0.78, {P} = 0.014) and/or to {W}orld {H}ealth {O}rganization stage 4 event (time ratio: 0.27, 95% {CI}: 0.09 to 0.79, {P} = 0.017).{C}onclusions:{O}ur study provides important evidence that {A}frican men are more vulnerable to {ART} failure than women and that the male vulnerability extends beyond adherence issues. {A}dditional studies are needed to determine the causes for this vulnerability to optimize {HIV} care. {H}owever, personalized adherence support remains crucial.},
  keywords = {{HIV} ; sub-{S}aharan {A}frica ; gender ; antiretroviral treatment ; outcomes ; {CAMEROUN}},
  booktitle = {},
  journal = {{J}aids.{J}ournal of {A}cquired {I}mmune {D}eficiency {S}yndromes},
  volume = {69},
  numero = {3},
  pages = {355--364},
  ISSN = {1525-4135},
  year = {2015},
  DOI = {10.1097/qai.0000000000000604},
  URL = {https://www.documentation.ird.fr/hor/fdi:010064751},
}