TY - JOUR
T1 - Uptake of WHO recommendations for first-line antiretroviral therapy in Kenya, Uganda, and Zambia
AU - Duber, Herbert C.
AU - Dansereau, Emily
AU - Masters, Samuel H.
AU - Achan, Jane
AU - Burstein, Roy
AU - DeCenso, Brendan
AU - Gasasira, Anne
AU - Ikilezi, Gloria
AU - Kisia, Caroline
AU - Masiye, Felix
AU - Njuguna, Pamela
AU - Odeny, Thomas
AU - Okiro, Emelda
AU - Roberts, D. Allen
AU - Gakidou, Emmanuela
N1 - Funding Information:
The authors would like to acknowledge all the individuals that contributed to this study, especially the essential contributions of our collaborators in Zambia (University of Zambia, Department of Economics), Uganda (Infectious Disease Research Collaboration), and Kenya (Action Africa Help-International), as well as IHME staff Kelsey Moore, Annie Haakenstad, and Aubrey Levine. We would also like to acknowledge the Bill & Melinda Gates Foundation for the funding of this project through various streams of support, including through the Disease Control Priorities Network grant.
Publisher Copyright:
© 2015 Duber et al.
PY - 2015/3/25
Y1 - 2015/3/25
N2 - Introduction: Antiretroviral therapy (ART) guidelines were significantly changed by the World Health Organization in 2010. It is largely unknown to what extent these guidelines were adopted into clinical practice. Methods: This was a retrospective observational analysis of first-line ART regimens in a sample of health facilities providing ART in Kenya, Uganda, and Zambia between 2007-2008 and 2011-2012. Data were analyzed for changes in regimen over time and assessed for key patient- and facility-level determinants of tenofovir (TDF) utilization in Kenya and Uganda using a mixed effects model. Results: Data were obtained from 29,507 patients from 146 facilities. The overall percentage of patients initiated on TDF-based therapy increased between 2007-2008 and 2011-2012 from 3% to 37% in Kenya, 2% to 34% in Uganda, and 64% to 87% in Zambia. A simultaneous decrease in stavudine (d4T) utilization was also noted, but its use was not eliminated, and there remained significant variation in facility prescribing patterns. For patients initiating ART in 2011-2012, we found increased odds of TDF use with more advanced disease at initiation in both Kenya (odds ratio [OR]: 2.78; 95% confidence interval [CI]: 1.73-4.48) and Uganda (OR: 2.15; 95% CI: 1.46-3.17). Having a CD4 test performed at initiation was also a significant predictor in Uganda (OR: 1.43; 95% CI: 1.16-1.76). No facility-level determinants of TDF utilization were seen in Kenya, but private facilities (OR: 2.86; 95% CI: 1.45-5.66) and those employing a doctor (OR: 2.86; 95% CI: 1.48-5.51) were more likely to initiate patients on TDF in Uganda. Discussion: d4T-based ART has largely been phased out over the study period. However, significant incountry and cross-country variation exists. Among the most recently initiated patients, those with more advanced disease at initiation were most likely to start TDF-based treatment. No facility-level determinants were consistent across countries to explain the observed facility-level variation.
AB - Introduction: Antiretroviral therapy (ART) guidelines were significantly changed by the World Health Organization in 2010. It is largely unknown to what extent these guidelines were adopted into clinical practice. Methods: This was a retrospective observational analysis of first-line ART regimens in a sample of health facilities providing ART in Kenya, Uganda, and Zambia between 2007-2008 and 2011-2012. Data were analyzed for changes in regimen over time and assessed for key patient- and facility-level determinants of tenofovir (TDF) utilization in Kenya and Uganda using a mixed effects model. Results: Data were obtained from 29,507 patients from 146 facilities. The overall percentage of patients initiated on TDF-based therapy increased between 2007-2008 and 2011-2012 from 3% to 37% in Kenya, 2% to 34% in Uganda, and 64% to 87% in Zambia. A simultaneous decrease in stavudine (d4T) utilization was also noted, but its use was not eliminated, and there remained significant variation in facility prescribing patterns. For patients initiating ART in 2011-2012, we found increased odds of TDF use with more advanced disease at initiation in both Kenya (odds ratio [OR]: 2.78; 95% confidence interval [CI]: 1.73-4.48) and Uganda (OR: 2.15; 95% CI: 1.46-3.17). Having a CD4 test performed at initiation was also a significant predictor in Uganda (OR: 1.43; 95% CI: 1.16-1.76). No facility-level determinants of TDF utilization were seen in Kenya, but private facilities (OR: 2.86; 95% CI: 1.45-5.66) and those employing a doctor (OR: 2.86; 95% CI: 1.48-5.51) were more likely to initiate patients on TDF in Uganda. Discussion: d4T-based ART has largely been phased out over the study period. However, significant incountry and cross-country variation exists. Among the most recently initiated patients, those with more advanced disease at initiation were most likely to start TDF-based treatment. No facility-level determinants were consistent across countries to explain the observed facility-level variation.
UR - https://www.scopus.com/pages/publications/84961287924
U2 - 10.1371/journal.pone.0120350
DO - 10.1371/journal.pone.0120350
M3 - Article
C2 - 25807553
AN - SCOPUS:84961287924
SN - 1932-6203
VL - 10
JO - PloS one
JF - PloS one
IS - 3
M1 - e0120350
ER -