Original Research

High rate of virological re-suppression among patients failing second-line antiretroviral therapy following enhanced adherence support: A model of care in Khayelitsha, South Africa

D B Garone, K Conradie, G Patten, M Cornell, W Goemaere, J Kunene, B Kerschberger, N Ford, A Boulle, G van Cutsem
Southern African Journal of HIV Medicine | Vol 14, No 4 | a52 | DOI: https://doi.org/10.4102/sajhivmed.v14i4.52 | © 2013 D B Garone, K Conradie, G Patten, M Cornell, W Goemaere, J Kunene, B Kerschberger, N Ford, A Boulle, G van Cutsem | This work is licensed under CC Attribution 4.0
Submitted: 12 December 2013 | Published: 22 November 2013

About the author(s)

D B Garone, Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa
K Conradie, Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa
G Patten, Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa
M Cornell, Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
W Goemaere, South African Medical Unit, Médecins Sans Frontières, Johannesburg, South Africa; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
J Kunene, Ubuntu Clinic, Provincial Department of the Western Cape, South Africa
B Kerschberger, Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa
N Ford, Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Ubuntu Clinic, Provincial Department of the Western Cape, South Africa; Médecins Sans Frontières, Geneva, Switzerland
A Boulle, Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
G van Cutsem, Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa; South African Medical Unit, Médecins Sans Frontières, Johannesburg, South Africa; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa


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Abstract

Objective. To describe and evaluate the outcomes of a support programme for patients with virological failure while receiving second-line antiretroviral therapy (ART) in South Africa.

Method. We described a comprehensive medical and counselling patient support programme for patients receiving secondline ART and with two consecutive viral loads (VLs) >1 000 copies/ml. Patients with >3 months follow-up and at least one VL measurement after inclusion in the programme were eligible for analysis.

Results. Of 69 patients enrolled in the programme, 40 had at least one follow-up VL and no known drug resistance at enrolment; 27 (68%) of these re-suppressed while remaining on second-line ART following enhanced adherence support. The majority (18/27; 67%) achieved re-suppression within the first 3 months in the programme. Five patients with diagnosed second-line drug resistance achieved viral re-suppression (<400 copies/ml) after being switched to third-line ART. Seven patients (7/40; 18%) did not achieve viral re-suppression after 9 months in the programme: 6 with known adherence problems (4 without drug resistance on genotype) and 1 with a VL <1 000 copies/ml. Overall, 3 patients (4%) died, 3 (4%) were lost to follow-up and 2 (3%) were transferred out.

Conclusion. Our experience from a routine programme demonstrates that with targeted adherence support, the majority of patients who were viraemic while receiving second-line ART returned to an undetectable VL within 3 months. By increasing the time receiving second-line ART and decreasing the need for genotypes and/or third-line ART, this intervention may reduce costs.


Keywords

second-line ART; failure; virological re-suppression; antiretroviral therapy

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