Drug Side Effects and Retention on HIV Treatment: a Regression Discontinuity Study of Tenofovir Implementation in South Africa and Zambia.

Drug Side Effects and Retention on HIV Treatment: a Regression Discontinuity Study of Tenofovir Implementation in South Africa and Zambia. Am J Epidemiol. 2018 May 15;: Authors: Brennan AT, Bor J, Davies MA, Wandeler G, Prozesky H, Fatti G, Wood R, Stinson K, Tanser F, Bärnighausen T, Boulle A, Sikazwe I, Zanolini A, Fox MP Abstract Tenofovir is less toxic than other nucleoside reverse transcriptase inhibitors used in antiretroviral therapy (ART) and may improve retention of HIV-infected patients on ART. We assessed the impact of national guideline changes in South Africa (2010) and Zambia (2007) recommending tenofovir in first-line ART. We applied regression discontinuity in a prospective cohort of 52,294 HIV-infected adults initiating first-line ART within ±12-months of each guideline change. We compared outcomes in patients presenting just before/after the guideline changes using local linear regression and estimated intention-to-treat effects on initiation of tenofovir, retention in care, and other treatment outcomes at 24-months. We assessed complier causal effects among patients starting tenofovir. The new guidelines increased the percentage of patients initiating tenofovir in South Africa (risk difference (RD): 81%; 95% confidence interval (CI): 73, 89) and Zambia (RD: 42%; 95% CI: 38, 45). With the guideline change, single-drug substitutions decreased substantially in South Africa (RD: -15%; 95% CI:-18, -12). Starting tenof...
Source: Am J Epidemiol - Category: Epidemiology Authors: Tags: Am J Epidemiol Source Type: research