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dc.contributor.authorLankowski, Alexander
dc.contributor.authorKembabazi, Annet
dc.contributor.authorEmenyonu, Nneka
dc.contributor.authorMuzoora, Conrad
dc.contributor.authorGeng, Elvin
dc.contributor.authorMartin, Jeffrey N.
dc.contributor.authorSiedner, Mark Jacob
dc.contributor.authorHaberer
dc.contributor.authorHaberer, Jessica
dc.contributor.authorTsai, Alexander Chung-Yu
dc.contributor.authorBangsberg, David Roy
dc.date.accessioned2013-03-19T18:25:46Z
dc.date.issued2012
dc.identifier.citationSiedner, Mark J., Alexander Lankowski, Jessica E. Haberer, Annet Kembabazi, Nneka Emenyonu, Alexander C. Tsai, Conrad Muzoora, Elvin Geng, Jeffrey N. Martin, and David R. Bangsberg. 2012. Rethinking the “pre” in pre-therapy counseling: No benefit of additional visits prior to therapy on adherence or viremia in ugandans initiating ARVs. PLoS ONE 7(6): e39894.en_US
dc.identifier.issn1932-6203en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:10445612
dc.description.abstractBackground: Many guidelines recommend adherence counseling prior to initiating antiretrovirals (ARVs), however the additional benefit of pre-therapy counseling visits on early adherence is not known. We sought to assess for a benefit of adherence counseling visits prior to ARV initiation versus adherence counseling during the early treatment period. Methods: We performed a secondary analysis of data from a prospective cohort of HIV-infected patients in Mbarara, Uganda. Adults were enrolled upon initiation of ARVs. Our primary exposure of interest was ARV adherence counseling prior to initiating therapy (versus concurrent with initiation of therapy). Our outcomes of interest were: 1) average adherence >90% in first three months; 2) absence of treatment interruptions >72 hours in first three months; and 3) Viral load >400 copies/ml at the three month visit. We fit univariable and multivariable regression models, adjusted for predictors of ARV adherence, to estimate the association between additional pre-therapy counseling visits and our outcomes. Results: 300 participants had records of counseling, of whom 231 (77%) completed visits prior to initiation of ARVs and 69 (23%) on or shortly after initiation. Median age was 33, 71% were female, and median CD4 was 133 cell/ml. Median 90-day adherence was 95%. Participants who completed pre-therapy counseling visits had longer delays from ARV eligibility to initiation (median 49 vs 14 days, p<0.01). In multivariable analyses, completing adherence counseling prior to ARV initiation was not associated with average adherence >90% (AOR 0.8, 95%CI 0.4–1.5), absence of treatment gaps (AOR 0.7, 95%CI 0.2–1.9), or HIV viremia (AOR 1.1, 95%CI 0.4–3.1). Conclusions: Completion of adherence counseling visits prior to ARV therapy was not associated with higher adherence in this cohort of HIV-infected patients in Uganda. Because mortality and loss-to-follow-up remain high in the pre-ARV period, policy makers should reconsider whether counseling can be delivered with ARV initiation, especially in patients with advanced disease.en_US
dc.language.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi:10.1371/journal.pone.0039894en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383698/pdf/en_US
dash.licenseLAA
dc.subjectMedicineen_US
dc.subjectEpidemiologyen_US
dc.subjectInfectious Disease Epidemiologyen_US
dc.subjectInfectious Diseasesen_US
dc.subjectViral Diseasesen_US
dc.subjectHIVen_US
dc.subjectHIV diagnosis and managementen_US
dc.subjectHIV epidemiologyen_US
dc.subjectNon-Clinical Medicineen_US
dc.subjectHealth Care Policyen_US
dc.subjectHealth Education and Awarenessen_US
dc.subjectPublic Healthen_US
dc.subjectBehavioral and Social Aspects of Healthen_US
dc.titleRethinking the “Pre” in Pre-Therapy Counseling: No Benefit of Additional Visits Prior to Therapy on Adherence or Viremia in Ugandans Initiating ARVsen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS ONEen_US
dash.depositing.authorBangsberg, David Roy
dc.date.available2013-03-19T18:25:46Z
dc.identifier.doi10.1371/journal.pone.0039894*
dash.authorsorderedfalse
dash.contributor.affiliatedSiedner, Mark
dash.contributor.affiliatedTsai, Alexander
dash.contributor.affiliatedHaberer, Jessica
dash.contributor.affiliatedBangsberg, David R.


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