Medication possession ratio predicts antiretroviral regimens persistence in Peru.
In developing nations, the use of operational parameters (OPs) in the prediction of clinical care represents a missed opportunity to enhance the care process. We modeled the impact of multiple measurements of antiretroviral treatment (ART) adherence on antiretroviral treatment outcomes in Peru.Retro...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2013-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3788135?pdf=render |
| _version_ | 1819122865124933632 |
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| author | Jorge L Salinas Jorge L Alave Andrew O Westfall Jorge Paz Fiorella Moran Danny Carbajal-Gonzalez David Callacondo Odalie Avalos Martin Rodriguez Eduardo Gotuzzo Juan Echevarria James H Willig |
| author_facet | Jorge L Salinas Jorge L Alave Andrew O Westfall Jorge Paz Fiorella Moran Danny Carbajal-Gonzalez David Callacondo Odalie Avalos Martin Rodriguez Eduardo Gotuzzo Juan Echevarria James H Willig |
| author_sort | Jorge L Salinas |
| collection | DOAJ |
| description | In developing nations, the use of operational parameters (OPs) in the prediction of clinical care represents a missed opportunity to enhance the care process. We modeled the impact of multiple measurements of antiretroviral treatment (ART) adherence on antiretroviral treatment outcomes in Peru.Retrospective cohort study including ART naïve, non-pregnant, adults initiating therapy at Hospital Nacional Cayetano Heredia, Lima-Peru (2006-2010). Three OPs were defined: 1) Medication possession ratio (MPR): days with antiretrovirals dispensed/days on first-line therapy; 2) Laboratory monitory constancy (LMC): proportion of 6 months intervals with ≥1 viral load or CD4 reported; 3) Clinic visit constancy (CVC): proportion of 6 months intervals with ≥1 clinic visit. Three multi-variable Cox proportional hazard (PH) models (one per OP) were fit for (1) time of first-line ART persistence and (2) time to second-line virologic failure. All models were adjusted for socio-demographic, clinical and laboratory variables.856 patients were included in first-line persistence analyses, median age was 35.6 years [29.4-42.9] and most were male (624; 73%). In multivariable PH models, MPR (per 10% increase HR=0.66; 95%CI=0.61-0.71) and LMC (per 10% increase 0.83; 0.71-0.96) were associated with prolonged time on first-line therapies. Among 79 individuals included in time to second-line virologic failure analyses, MPR was the only OP independently associated with prolonged time to second-line virologic failure (per 10% increase 0.88; 0.77-0.99).The capture and utilization of program level parameters such as MPR can provide valuable insight into patient-level treatment outcomes. |
| first_indexed | 2024-12-22T06:59:14Z |
| format | Article |
| id | doaj.art-a7907e7a70394b66bd98a5be6734b861 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-22T06:59:14Z |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-a7907e7a70394b66bd98a5be6734b8612022-12-21T18:34:51ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-01810e7632310.1371/journal.pone.0076323Medication possession ratio predicts antiretroviral regimens persistence in Peru.Jorge L SalinasJorge L AlaveAndrew O WestfallJorge PazFiorella MoranDanny Carbajal-GonzalezDavid CallacondoOdalie AvalosMartin RodriguezEduardo GotuzzoJuan EchevarriaJames H WilligIn developing nations, the use of operational parameters (OPs) in the prediction of clinical care represents a missed opportunity to enhance the care process. We modeled the impact of multiple measurements of antiretroviral treatment (ART) adherence on antiretroviral treatment outcomes in Peru.Retrospective cohort study including ART naïve, non-pregnant, adults initiating therapy at Hospital Nacional Cayetano Heredia, Lima-Peru (2006-2010). Three OPs were defined: 1) Medication possession ratio (MPR): days with antiretrovirals dispensed/days on first-line therapy; 2) Laboratory monitory constancy (LMC): proportion of 6 months intervals with ≥1 viral load or CD4 reported; 3) Clinic visit constancy (CVC): proportion of 6 months intervals with ≥1 clinic visit. Three multi-variable Cox proportional hazard (PH) models (one per OP) were fit for (1) time of first-line ART persistence and (2) time to second-line virologic failure. All models were adjusted for socio-demographic, clinical and laboratory variables.856 patients were included in first-line persistence analyses, median age was 35.6 years [29.4-42.9] and most were male (624; 73%). In multivariable PH models, MPR (per 10% increase HR=0.66; 95%CI=0.61-0.71) and LMC (per 10% increase 0.83; 0.71-0.96) were associated with prolonged time on first-line therapies. Among 79 individuals included in time to second-line virologic failure analyses, MPR was the only OP independently associated with prolonged time to second-line virologic failure (per 10% increase 0.88; 0.77-0.99).The capture and utilization of program level parameters such as MPR can provide valuable insight into patient-level treatment outcomes.http://europepmc.org/articles/PMC3788135?pdf=render |
| spellingShingle | Jorge L Salinas Jorge L Alave Andrew O Westfall Jorge Paz Fiorella Moran Danny Carbajal-Gonzalez David Callacondo Odalie Avalos Martin Rodriguez Eduardo Gotuzzo Juan Echevarria James H Willig Medication possession ratio predicts antiretroviral regimens persistence in Peru. PLoS ONE |
| title | Medication possession ratio predicts antiretroviral regimens persistence in Peru. |
| title_full | Medication possession ratio predicts antiretroviral regimens persistence in Peru. |
| title_fullStr | Medication possession ratio predicts antiretroviral regimens persistence in Peru. |
| title_full_unstemmed | Medication possession ratio predicts antiretroviral regimens persistence in Peru. |
| title_short | Medication possession ratio predicts antiretroviral regimens persistence in Peru. |
| title_sort | medication possession ratio predicts antiretroviral regimens persistence in peru |
| url | http://europepmc.org/articles/PMC3788135?pdf=render |
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