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Implementation and Operational Research: Correlates of Adherence and Treatment Failure Among Kenyan Patients on Long-term Highly Active Antiretroviral Therapy

Ochieng, Washingtone MSc, MBA, PhD; Kitawi, Rose C. BPharm; Nzomo, Timothy J. BSc; Mwatelah, Ruth S. BSc; Kimulwo, Maureen J. BSc; Ochieng, Dorothy J. MSc; Kinyua, Joyceline MSc; Lagat, Nancy BSc; Onyango, Kevin O. MBChB; Lwembe, Raphael M. PhD; Mwamburi, Mkaya MD, PhD; Ogutu, Bernhards R. MBChB, MMed, PhD; Oloo, Florence A. PhD; Aman, Rashid BPharm, PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1st, 2015 - Volume 69 - Issue 2 - p e49–e56
doi: 10.1097/QAI.0000000000000580
Epidemiology and Prevention

Background: Universal access to highly active antiretroviral therapy (HAART) is still elusive in most developing nations. We asked whether peer support influenced adherence and treatment outcome and if a single viral load (VL) could define treatment failure in a resource-limited setting.

Methods: A multicenter longitudinal and cross-sectional survey of VL, CD4 T cells, and adherence in 546 patients receiving HAART for up to 228 months. VL and CD4 counts were determined using m2000 Abbott RealTime HIV-1 assay and FACS counters, respectively. Adherence was assessed based on pill count and on self-report.

Results: Of the patients, 55.8%, 22.2%, and 22% had good, fair, and poor adherence, respectively. Adherence, peer support, and regimen, but not HIV disclosure, age, or gender, independently correlated with VL and durability of treatment in a multivariate analysis (P < 0.001). Treatment failure was 35.9% using sequential VL but ranged between 27% and 35% using alternate single VL cross-sectional definitions. More patients failed stavudine (41.2%) than zidovudine (37.4%) or tenofovir (28.8%, P = 0.043) treatment arms. Peer support correlated positively with adherence (χ2, P < 0.001), with nonadherence being highest in the stavudine arm. VL before the time of regimen switch was comparable between patients switching and not switching treatment. Moreover, 36% of those switching still failed the second-line regimen.

Conclusion: Weak adherence support and inaccessible VL testing threaten to compromise the success of HAART scale-up in Kenya. To hasten antiretroviral therapy monitoring and decision making, we suggest strengthening patient-focused adherence programs, optimizing and aligning regimen to WHO standards, and a single point-of-care VL testing when multiple tests are unavailable.

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*Center for Research in Therapeutic Sciences and the Institute of Healthcare Management, Strathmore University, Nairobi, Kenya;

Kenya Medical Research Institute, Nairobi, Kenya;

Institute of Tropical Medicine and Infectious Diseases at JKUAT, Nairobi, Kenya;

§MCPHS University, Worcester, MA;

Center for Global Public Health, Tufts University School of Medicine, Boston, MA; and

African Centre for Clinical Trials, Nairobi, Kenya.

Correspondence to: Washingtone Ochieng, MSc, MBA, PhD, Centrer for Research in Therapeutic Sciences, Strathmore University, P.O. Box 59857-00200, Nairobi, Kenya (e-mail:

Supported by the Consortium for National Health Research (Kenya) Grant# RCDG-2012-005, with funds from the Wellcome Trust and the Department for International Development (DFID), UK (Grant ID, WT080883Kokwaro).

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received August 21, 2014

Accepted January 13, 2015

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