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There are few studies comparing drug resistance profiles in patients accessing treatment through these programmes. The aim of this study was to perform such a comparison.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> drug resistance data and associated treatment and monitoring information for adult patients failing first\u2010line therapy in an urban and a rural programme were collected. Data were curated and managed in <jats:styled-content style=\"fixed-case\">SAT<\/jats:styled-content>u<jats:styled-content style=\"fixed-case\">RN<\/jats:styled-content> Rega<jats:styled-content style=\"fixed-case\">DB<\/jats:styled-content> before statistical analysis using Microsoft Excel 2013 and <jats:sc>stata<\/jats:sc> Ver14, in which clinical parameters, resistance profiles and predicted treatment responses were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data for 595 patients were analysed: 492 patients from a rural setting and 103 patients from an urban setting. The urban group had lower <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4 counts at treatment initiation than the rural group (98 <jats:italic>vs<\/jats:italic>. 126 cells\/<jats:italic>\u03bc<\/jats:italic>L, respectively; <jats:italic>P<\/jats:italic> = 0.05), had more viral load measurements performed per year (median 3 <jats:italic>vs<\/jats:italic>. 1.4, respectively; <jats:italic>P<\/jats:italic> &lt; 0.01) and were more likely to have no drug resistance mutations detected (35.9% <jats:italic>vs<\/jats:italic>. 11.2%, respectively; <jats:italic>P<\/jats:italic> &lt; 0.01). Patients in the rural group were more likely to have been on first\u2010line treatment for a longer period, to have failed for longer, and to have thymidine analogue mutations. Notwithstanding these differences, the two groups had comparable predicted responses to the standard second\u2010line regimen, based on the genotypic susceptibility score. Mutations accumulated in a sigmoidal fashion over failure duration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The frequency and patterns of drug resistance, as well the intensity of virological monitoring, in adults with first\u2010line therapy failure differed between the urban and rural sites. Despite these differences, based on the genotypic susceptibility scores, the majority of patients across the two sites would be expected to respond well to the standard second\u2010line regimen.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.12400","type":"journal-article","created":{"date-parts":[[2016,6,29]],"date-time":"2016-06-29T16:26:39Z","timestamp":1467217599000},"page":"104-114","source":"Crossref","is-referenced-by-count":23,"title":["<scp>HIV<\/scp> drug resistance levels in adults failing first\u2010line antiretroviral therapy in an urban and a rural setting in <scp>S<\/scp>outh <scp>A<\/scp>frica"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4066-922X","authenticated-orcid":false,"given":"TM","family":"Rossouw","sequence":"first","affiliation":[{"name":"Department of Immunology Institute for Cellular and Molecular Medicine University of Pretoria Pretoria South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Nieuwoudt","sequence":"additional","affiliation":[{"name":"South African Department of Science and Technology\/National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA) Stellenbosch University Stellenbosch South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Manasa","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Stanford University Stanford CA USA"},{"name":"Africa Centre Population Health University of KwaZulu\u2010Natal South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Malherbe","sequence":"additional","affiliation":[{"name":"Department of Immunology Institute for Cellular and Molecular Medicine University of Pretoria Pretoria South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RJ","family":"Lessells","sequence":"additional","affiliation":[{"name":"Africa Centre Population Health University of KwaZulu\u2010Natal South Africa"},{"name":"Department of Clinical Research London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Pillay","sequence":"additional","affiliation":[{"name":"Africa Centre Population Health University of KwaZulu\u2010Natal South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Danaviah","sequence":"additional","affiliation":[{"name":"Africa Centre Population Health University of KwaZulu\u2010Natal South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Mahasha","sequence":"additional","affiliation":[{"name":"Department of Immunology Institute for Cellular and Molecular Medicine University of Pretoria Pretoria South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"van Dyk","sequence":"additional","affiliation":[{"name":"Department of Immunology Institute for Cellular and Molecular Medicine University of Pretoria Pretoria South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Africa Centre Population Health University of KwaZulu\u2010Natal South Africa"},{"name":"Research Department of Infection University College London London UK"},{"name":"School of Laboratory Medicine and Medical Sciences Nelson R. 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