%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Bastard, M.
%A Fall, M. B. K.
%A Lanièce, I.
%A Taverne, Bernard
%A Desclaux, Alice
%A Ecochard, R.
%A Sow, P. S.
%A Delaporte, Eric
%A Etard, Jean-François
%T Revisiting long-term adherence to highly active antiretroviral therapy in Senegal using latent class analysis
%D 2011
%L fdi:010053486
%G ENG
%J Jaids-Journal of Acquired Immune Deficiency Syndromes
%@ 1525-4135
%K antiretroviral therapy ; adherence ; latent class analysis ; mixed model ; women ; Senegal
%M ISI:000289509100015
%N 1
%P 55-61
%R 10.1097/QAI.0b013e318211b43b
%U https://www.documentation.ird.fr/hor/fdi:010053486
%> https://www.documentation.ird.fr/intranet/publi/2011/05/010053486.pdf
%V 57
%W Horizon (IRD)
%X Background: Adherence is one of the main predictors of antiretroviral treatment success. A governmental initiative was launched in 1998 for HIV-infected patients in Senegal to provide access to highly active antiretroviral therapy. Methods: Between August 1998 and April 2002, 404 adult patients were enrolled. Adherence measurements, defined as pills taken/pills prescribed, were assessed between November 1999 and April 2009 using a pill count along with a questionnaire for 330 patients. Predictors of adherence were explored through a random-intercept Tobit model and a latent class analysis (LCA) was performed to identify adherence trajectories. We also performed a survival analysis taking into account gender and latent adherence classes. Results: Median treatment duration was 91 months (interquartile range, 84-101). On average, adherence declined by 7% every year, was 30% lower for patients taking indinavir, and 12% higher for those receiving cotrimoxazole prophylaxis. Based on the predicted probability of having an adherence >= 95%, LCA revealed 3 adherence behaviors and a better adherence for women. A quarter of patients had a high adherence trajectory over time and half had an intermediate one. Male gender and low adherence behavior over time were independently associated with a higher mortality rate. Conclusions: This study shows that an overall good adherence can be obtained in the long term in Senegal. LCA suggests a better adherence for women and points out a large subsample of patients with intermediate level of adherence behavior who are at risk for developing resistance to antiretroviral drugs. This study warrants further research into gender issues.
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