Original Research
Delays in switching patients onto second-line antiretroviral treatment at a public hospital in eThekwini, KwaZulu-Natal
Submitted: 23 September 2016 | Published: 31 March 2017
About the author(s)
Denver Narainsamy, School of Nursing and Public Health, University of KwaZulu-Natal, South AfricaSaajida Mahomed, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, South Africa
Abstract
Aim: To identify the patient-related and programmatic factors that delay switching patients onto second-line ART, and to assess whether these delays contribute to subsequent virological failure.
Methods: Clinical records of adult patients switched onto second-line ART between 2011 and 2014 at a public antiretroviral clinic were used to collect demographic, clinical, laboratory and programmatic data (availability of viral load results, inadequate patient follow-up, insufficient notes for effective follow-up). Data were analysed using univariate and multivariate logistic regression.
Results: The median duration from the date of first and confirmatory documented high viral load (VL > 1000 copies/mL) to being switched to second-line ART was 13.2 months [interquartile range (IQR) 1.1–52.7 months] and 6.4 months (IQR 0–43.3 months), respectively. Inadequate prescriber notes for appropriate follow-up (p = 0.01) and unavailability of patients’ viral load results (p = 0.02) were significantly associated with delays in switching to second-line ART. There was no significant association between the time taken to switch to second-line ART and subsequent virological failure.
Conclusion: We observed lengthy delays in switching patients to second-line ART. Modifiable programmatic factors were found to be significantly associated with delays in switching to second-line ART.
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Crossref Citations
1. Simplifying switch to second-line antiretroviral therapy in sub Saharan Africa
Amir Shroufi, Gilles Van Cutsem, Valentina Cambiano, Loveleen Bansi-Matharu, Kristal Duncan, Richard A. Murphy, David Maman, Andrew Phillips
AIDS vol: 33 issue: 10 first page: 1635 year: 2019
doi: 10.1097/QAD.0000000000002234