Adherence to both cotrimoxazole and placebo is associated with improved survival among HIV-infected Zambian children

A. Sarah Walker, Deborah Ford, Veronica Mulenga, Margaret J. Thomason, Andrew Nunn, Chifumbe Chintu, Diana M. Gibb, David Bangsberg

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

In the CHAP randomized placebo-controlled trial of cotrimoxazole prophylaxis in HIV-infected Zambian children conducted between 2001 and 2003, cotrimoxazole was associated with significant mortality reductions. In a secondary analysis we used Cox regression models to estimate the association between adherence measured by bottle weights and caregiver report and subsequent mortality in children surviving >28 days (n = 496, 153 deaths). Adherence was high and similar in both cotrimoxazole and placebo groups; adherence from bottle weights was 100% at 71% of visits, while caregivers reported 100% adherence at 79% of visits. Every 10% lower adherence to cotrimoxazole or placebo measured by bottle weights was associated with a 10-11% increase in mortality risk. Effects remained after adjustment for baseline predictors of survival and for current and recent change in primary caregiver. Caregiver-reported adherence was not associated with survival. The association between bottle-weight adherence to placebo and survival is likely capturing unmeasured caregiver effects, whose identification will be essential for quantifying the impact of antiretroviral therapy (ART) adherence on clinical outcomes in children.

Original languageEnglish (US)
Pages (from-to)33-41
Number of pages9
JournalAIDS and Behavior
Volume13
Issue number1
DOIs
StatePublished - Feb 2009
Externally publishedYes

Fingerprint

Sulfamethoxazole Drug Combination Trimethoprim
Caregivers
Placebos
HIV
Survival
Weights and Measures
Child Mortality
Mortality
Proportional Hazards Models
Randomized Controlled Trials

Keywords

  • Adherence
  • Africa
  • Cotrimoxazole
  • HIV

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases
  • Social Psychology

Cite this

Adherence to both cotrimoxazole and placebo is associated with improved survival among HIV-infected Zambian children. / Walker, A. Sarah; Ford, Deborah; Mulenga, Veronica; Thomason, Margaret J.; Nunn, Andrew; Chintu, Chifumbe; Gibb, Diana M.; Bangsberg, David.

In: AIDS and Behavior, Vol. 13, No. 1, 02.2009, p. 33-41.

Research output: Contribution to journalArticle

Walker, A. Sarah ; Ford, Deborah ; Mulenga, Veronica ; Thomason, Margaret J. ; Nunn, Andrew ; Chintu, Chifumbe ; Gibb, Diana M. ; Bangsberg, David. / Adherence to both cotrimoxazole and placebo is associated with improved survival among HIV-infected Zambian children. In: AIDS and Behavior. 2009 ; Vol. 13, No. 1. pp. 33-41.
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