[Compliance in HIV infected adults. Study of opportunistic infection prophylaxis with cotrimoxazole in Ivory Coast].

Abstract

BACKGROUND:

The compliance to a daily treatment for illimited duration and the factors that influence it have been rarely studied in sub-Saharian Africa.

OBJECTIVE:

Describe the compliance to prophylaxis with cotrimoxazole fort (one tablet per day) and its associated factors in patients infected by HIV participating in a clinical trial in Abidjan.

METHOD:

The tablets packed in individual blisters were provided every month, and the blisters were recuperated the following month. A global compliance ratio (GCR) was established for each patient (empty blisters at the end of the study/follow-up period during the study) and monthly compliance ratio [MCR] (empty blisters during a visit/time lapse since last visit). For each monthly visit foreseen in the protocol, a respect of the appointment ratio (RAR) was described (visits foreseen in the protocol respected that month/visits foreseen in the protocol). The association of GCR with the characteristics on inclusion was studied using logistic regression methods.

RESULTS:

530 adults were followed-up for a mean of 10 months. The MCR and the RAR progressed in parallel, decreasing the first 5 months and stabilizing at around 0.80 for the RAR and 0.70 for the MCR. The mean GCR was of 0.77. Three hundred and nine patients (58%) were considered as compliant (0.80<GCR<1). In multivariate analysis, those belonging to the group of compliers were associated with a paid occupation and with a past of tuberculosis, and was not associated with age, gender, level of education, nationality, civil status, number of persons in the home, proximity of a care center, clinical grade or CD4.

DISCUSSION:

The estimated compliance was correct and stable. The association with a history of tuberculosis suggests that a person having already followed prolonged daily treatment would be more readily compliant to other long term treatments.

CONCLUSION:

In Africa, cotrimoxazole is initiated long before the stage of antiretroviral treatment. The concern regarding the efficacy of such prophylaxis raises the question of compliance early on in the disease. This prepares the teams that organise the management of such patients to being faced with the problems of compliance to antiretrovirals.

• Authors: G Gourvellec, X Anglaret, S Touré, C Huët, N Dakoury-Dogbo, S Lafont, T N'Dri-Yoman, G Chêne, R Salamon, ANRS 1203
• Journal: Presse medicale (Paris, France : 1983) (Presse Med) Vol. 33 Issue 9 Pt 1 Pg. 595-600 (May 22 2004) ISSN: 0755-4982 [Print] France
• Vernacular Title: Observance chez les adultes infectés par le VIH. Etude d'une prophylaxie des infections opportunistes par le cotrimoxazole en Côte d'Ivoire.
• PMID: 15226691 (Publication Type: Clinical Trial, English Abstract, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Infective Agents
• Trimethoprim, Sulfamethoxazole Drug Combination

Topics

• AIDS-Related Opportunistic Infections (prevention & control)
• Administration, Oral
• Adult
• Anti-Infective Agents (therapeutic use)
• CD4 Lymphocyte Count
• Cote d'Ivoire
• Educational Status
• Female
• Follow-Up Studies
• HIV Infections (complications, immunology, psychology)
• Humans
• Logistic Models
• Male
• Multivariate Analysis
• Occupations
• Patient Compliance (psychology, statistics & numerical data)
• Risk Factors
• Severity of Illness Index
• Socioeconomic Factors
• Trimethoprim, Sulfamethoxazole Drug Combination (therapeutic use)
• Tuberculosis (complications, psychology)
• Urban Population