Skip to main content

Free Content The impact of first year adherence to antiretroviral therapy on long‐term clinical and immunological outcomes in the DART trial in Uganda and Zimbabwe

Download Article:

You have access to the full text article on a website external to Ingenta Connect.

Please click here to view this article on Wiley Online Library.

You may be required to register and activate access on Wiley Online Library before you can obtain the full text. If you have any queries please visit Wiley Online Library


Objectives  To describe associations between different summaries of adherence in the first year on antiretroviral therapy (ART) and the subsequent risk of mortality, to identify patients at high risk because of early adherence behaviour.

Methods  We previously described an approach where adherence behaviour at successive clinic visits during the first year on ART was seen as a Markov chain (MC), and the individually estimated transition probabilities between ‘good’, ‘poor’ and ‘non‐response’ adherence states were used to classify HIV‐infected adults in the DART trial into subgroups with similar behaviour. The impact of this classification and classifications based on traditional ‘averaged’ measures [mean drug possession ratio (DPR) and self‐reported adherence] were compared in terms of their impact on longer‐term mortality over the 2–5 years on ART using Cox proportional hazards models.

Results  Of 2960 participants in follow‐up after 1 year on ART, 29% had never missed pills in the last month and 11% had 100% DPR throughout the first year. The poorest adherers by self‐reported measures were more likely to have only none/primary education (P < 0.01). Being in the poorest adherence subgroup by MC and DPR was independently associated with increased mortality [HR = 1.57 (95% CI 1.02, 2.42); 1.82 (1.32, 2.51) respectively].

Conclusions  Classification based on dynamic adherence behaviour is associated with mortality independently of DPR. The classifications could be useful in understanding adherence, targeting focused interventions and improving longer‐term adherence to therapy.
No References
No Citations
No Supplementary Data
No Article Media
No Metrics

Language: English

Document Type: Research Article

Affiliations: 1:  Medical Research Council Clinical Trials Unit, London, UK 2:  School of Health Sciences, University of Tampere, Finland 3:  MRC Uganda Virus Research Institute, Entebbe, Uganda 4:  Infectious Diseases Institute, Makerere University, Kampala, Uganda 5:  Joint Clinical Research Centre, Kampala, Uganda 6:  College of Health Sciences, University of Harare, Harare, Zimbabwe 7:  London School of Hygiene and Tropical Medicine, London, UK

Publication date: 01 May 2012

  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content
Cookie Policy
Cookie Policy
Ingenta Connect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more