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Using electronic methods of adherence monitoring and therapeutic drug monitoring (TDM) to eliminate discordance between antiretroviral adherence and virological failure
Background: Adherence to antiretroviral therapy (ART) is critical: only 70% achieve viral suppression at a year. Current adherence methodologies, with slow reaction to missed dosing, inadequately predict virological outcomes. Ideal adherence methods would be cheap, easy to use, and allow rapid respo...
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| Format: | Thesis |
| Language: | English |
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Department of Medicine
2016
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| _version_ | 1867611336529149952 |
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| access_status_str | Open Access |
| author | Orrell, Catherine |
| author2 | Wood, Robin |
| author_browse | Orrell, Catherine Wood, Robin |
| author_facet | Wood, Robin Orrell, Catherine |
| author_sort | Orrell, Catherine |
| collection | Thesis |
| description | Background: Adherence to antiretroviral therapy (ART) is critical: only 70% achieve viral suppression at a year. Current adherence methodologies, with slow reaction to missed dosing, inadequately predict virological outcomes. Ideal adherence methods would be cheap, easy to use, and allow rapid response to missed doses to improve outcomes. We explored ideal adherence monitoring methodology for a large public sector ART clinic in Cape Town. Methods: We designed a randomised controlled study for ART-naïve individuals to determine whether text messaging after a missed dose would improve adherence recorded by an electronic adherence monitoring device (EAMD), reduce treatment interruptions or impact on virological outcome (using regression modelling). Five other measures of adherence were captured prospectively during the study: selfrecall (SR), clinic-based pill count (CPC), pharmacy refill data (PR-average or PR-gaps) and efavirenz concentration. The predictive value of each adherence methodology on virological and HIV-1 resistance outcomes was compared by calculating the area under the receiver operating characteristic curve, from logistic regression models. The impact of efavirenz concentration and CYP2B6 metaboliser genotype data on failure was examined using Cox proportion hazard modelling; and the most predictive lower limit for EFV concentration was determined. Antiretroviral cohort and pharmacy refill data were compared, using simple statistics, to determine which provided the best method of determining those retained in care. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/20349 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2016 |
| publishDateRange | 2016 |
| publishDateSort | 2016 |
| publisher | Department of Medicine |
| publisherStr | Department of Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/20349 Using electronic methods of adherence monitoring and therapeutic drug monitoring (TDM) to eliminate discordance between antiretroviral adherence and virological failure Orrell, Catherine Wood, Robin Maartens, Gary Infectious Disease and Molecular Medicine Monitoring Background: Adherence to antiretroviral therapy (ART) is critical: only 70% achieve viral suppression at a year. Current adherence methodologies, with slow reaction to missed dosing, inadequately predict virological outcomes. Ideal adherence methods would be cheap, easy to use, and allow rapid response to missed doses to improve outcomes. We explored ideal adherence monitoring methodology for a large public sector ART clinic in Cape Town. Methods: We designed a randomised controlled study for ART-naïve individuals to determine whether text messaging after a missed dose would improve adherence recorded by an electronic adherence monitoring device (EAMD), reduce treatment interruptions or impact on virological outcome (using regression modelling). Five other measures of adherence were captured prospectively during the study: selfrecall (SR), clinic-based pill count (CPC), pharmacy refill data (PR-average or PR-gaps) and efavirenz concentration. The predictive value of each adherence methodology on virological and HIV-1 resistance outcomes was compared by calculating the area under the receiver operating characteristic curve, from logistic regression models. The impact of efavirenz concentration and CYP2B6 metaboliser genotype data on failure was examined using Cox proportion hazard modelling; and the most predictive lower limit for EFV concentration was determined. Antiretroviral cohort and pharmacy refill data were compared, using simple statistics, to determine which provided the best method of determining those retained in care. 2016-07-14T12:22:26Z 2016-07-14T12:22:26Z 2016 Doctoral Thesis Doctoral PhD http://hdl.handle.net/11427/20349 eng application/pdf Department of Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | Infectious Disease and Molecular Medicine Monitoring Orrell, Catherine Using electronic methods of adherence monitoring and therapeutic drug monitoring (TDM) to eliminate discordance between antiretroviral adherence and virological failure |
| thesis_degree_str | Doctoral |
| title | Using electronic methods of adherence monitoring and therapeutic drug monitoring (TDM) to eliminate discordance between antiretroviral adherence and virological failure |
| title_full | Using electronic methods of adherence monitoring and therapeutic drug monitoring (TDM) to eliminate discordance between antiretroviral adherence and virological failure |
| title_fullStr | Using electronic methods of adherence monitoring and therapeutic drug monitoring (TDM) to eliminate discordance between antiretroviral adherence and virological failure |
| title_full_unstemmed | Using electronic methods of adherence monitoring and therapeutic drug monitoring (TDM) to eliminate discordance between antiretroviral adherence and virological failure |
| title_short | Using electronic methods of adherence monitoring and therapeutic drug monitoring (TDM) to eliminate discordance between antiretroviral adherence and virological failure |
| title_sort | using electronic methods of adherence monitoring and therapeutic drug monitoring tdm to eliminate discordance between antiretroviral adherence and virological failure |
| topic | Infectious Disease and Molecular Medicine Monitoring |
| url | http://hdl.handle.net/11427/20349 |
| work_keys_str_mv | AT orrellcatherine usingelectronicmethodsofadherencemonitoringandtherapeuticdrugmonitoringtdmtoeliminatediscordancebetweenantiretroviraladherenceandvirologicalfailure |