Patient-Initiated Repackaging of Antiretroviral Therapy, Viral Suppression and Drug Resistance
Patient-initiated repackaging of antiretroviral therapy (ART) refers to removal of ART medications from their original manufacturer’s containers, and putting them into alternative containers. This behavior may be triggered by stigma associated with HIV infection, and may impact patient outcomes. We assessed association between patient initiated repackaging of ART and failure to achieve viral suppression (FVS) in a sample of 450 HIV-infected adults (≥8 years) on first line ART for ≥6 months. FVS was defined as a plasma HIV RNA level ≥400 copies/mL. A total of 197 (43.7%) patients reported repackaging their ART medications. One hundred ninety-one patients (42.4%) failed to suppress and FVS was associated with medication repackaging [adjusted odds ratio (aOR), 2.2; 95% CI 1.4–3.3.] Adherence to ART was also associated with FVS (aOR; 0.4; 95% CI 0.2–0.6.). Benefits of retaining drugs in their original packaging along with adherence to ART should be emphasized to reduce the risk of FVS.
KeywordsHIV Repackaging of anti-retro-viral Virological suppression Stigma ART resistance mutations
We thank the management of the 5 CTCs for invaluable assistance in conducting the study. We also thank study participants and other staff members for their assistance with this study. Moreover, we thank Godfrey Mushi, Gaudensia H. Lyimo and Rita P. Minja for conducting patient interviews and data collection.
This research was funded by the Duke Center For AIDS Research (CFAR), a National Institutes of Health-funded program (Grant Number P30 AI064518-06).
Compliance with Ethical Standards
Conflicts of interest
The authors have no conflicts of interest to declare.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 4.http://www.pharmaceutical-journal.com/libres/pdf/articles/pj_20060121_stable.pdf. Accessed 20 March 2016.
- 5.Heneghan CJ, Glasziou P, Perera R. Reminder packaging for improving adherence to self-administered long-term medications. Cochrane Database Syst Rev. 2006;1:Cd005025.Google Scholar
- 7.Peitzmeier SM, Grosso A, Bowes A, Ceesay N, Baral SD. Associations of stigma with negative health outcomes for people living with HIV in the Gambia: implications for key populations. J Acquir Immune Defic Syndr. 1999;2015(68 Suppl 2):S146–53.Google Scholar
- 8.Bezabhe WM, Chalmers L, Bereznicki LR, Peterson GM, Bimirew MA, Kassie DM. Barriers and facilitators of adherence to antiretroviral drug therapy and retention in care among adult HIV-positive patients: a qualitative study from Ethiopia. PLoS ONE. 2014;9(5):e97353.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.http://pmtct.or.tz/wp-content/uploads/2013/03/ART-guidelines_annexes.pdf. Accessed 31 Dec 2016.
- 13.Hassan AS, Nabwera HM, Mwaringa SM, Obonyo CA, Sanders EJ, Rinke de Wit TF, et al. HIV-1 virologic failure and acquired drug resistance among first-line antiretroviral experienced adults at a rural HIV clinic in coastal Kenya: a cross-sectional study. AIDS Res Ther. 2014;11(1):9.CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Ngarina M, Kilewo C, Karlsson K, Aboud S, Karlsson A, Marrone G, et al. Virologic and immunologic failure, drug resistance and mortality during the first 24 months postpartum among HIV-infected women initiated on antiretroviral therapy for life in the Mitra plus Study, Dar es Salaam, Tanzania. BMC Infect Dis. 2015;15:175.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Wilson IB, Bangsberg DR, Shen J, Simoni JM, Reynolds NR, Goggin K, et al. Heterogeneity among studies in rates of decline of antiretroviral therapy adherence over time: results from the multisite adherence collaboration on HIV 14 study. J Acquir Immune Defic Syndr. 2013;64(5):448–54.CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Genberg BL, Hlavka Z, Konda KA, Maman S, Chariyalertsak S, Chingono A, et al. A comparison of HIV/AIDS-related stigma in four countries: negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS. Soc Sci Med. 2009;68(12):2279–87.CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Berg KM, Arnsten JH. Practical and conceptual challenges in measuring antiretroviral adherence. J Acquir Immune Defic Syndr. 1999;2006(43 Suppl 1):S79–87.Google Scholar