{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:40:42Z","timestamp":1790138442190,"version":"4.0.1"},"reference-count":25,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2012,7,29]],"date-time":"2012-07-29T00:00:00Z","timestamp":1343520000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2012,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold>Objective\u2002<\/jats:bold> In 2007, Lesotho launched new national antiretroviral treatment (ART) guidelines, prioritising tenofovir and zidovudine over stavudine as a backbone together with lamivudine. We compared the rate of adoption of these new guidelines and substitution of first\u2010line drugs by health centers (HC) and hospitals in two catchment areas in rural Lesotho.<\/jats:p><jats:p><jats:bold>Methods\u2002<\/jats:bold> Retrospective cohort analysis. Patients aged \u226516\u2003years were stratified into a HC\u2010 and a hospital\u2010group. Main outcome variables: Type of backbone at ART\u2010initiation (i), substitutions within first line (ii) and type of backbone among patients retained by December 2010 (iii). A multiple logistic regression model including HC <jats:italic>vs.<\/jats:italic> hospital, patient characteristics (sex, age, WHO\u2010stage, baseline CD4\u2010count, concurrent pregnancy, concurrent tuberculosis treatment) and year of ART\u2010start, was used.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> Of 3936 adult patients initiated on ART between 2007 and 2010, 1971 started at hospitals and 1965 at HCs. Hospitals were more likely to follow the new guidelines as measured by prescription of backbones without stavudine (Odds\u2010ratio 1.55; 95%CI: 1.32\u20131.81) and had a higher rate of drug substitutions while on first\u2010line ART (2.39; 1.83\u20133.13). By December 2010, patients followed at health centres were more likely to still receive stavudine (2.28; 1.83\u20132.84).<\/jats:p><jats:p><jats:bold>Conclusions\u2002<\/jats:bold> Health centers took longer to adopt the new guidelines and substituted drugs less frequently. Decentralised ART\u2010programmes need close support, supervision and mentoring to absorb new guidelines and to adhere to them.<\/jats:p>","DOI":"10.1111\/j.1365-3156.2012.03051.x","type":"journal-article","created":{"date-parts":[[2012,7,30]],"date-time":"2012-07-30T01:50:29Z","timestamp":1343613029000},"page":"1245-1254","source":"Crossref","is-referenced-by-count":14,"title":["Adoption of new HIV treatment guidelines and drug substitutions within first\u2010line as a measure of quality of care in rural Lesotho: health centers and hospitals compared"],"prefix":"10.1111","volume":"17","author":[{"given":"Niklaus D.","family":"Labhardt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motlalepula","family":"Sello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thabo","family":"Lejone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen","family":"Ehmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohlaba","family":"Mokhantso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lutgarde","family":"Lynen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolin","family":"Pfeiffer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,7,29]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1086\/521114"},{"key":"e_1_2_6_3_1","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1177\/135965350701200508","article-title":"Substitutions due to antiretroviral toxicity or contraindication in the first 3\u2003years of antiretroviral therapy in a large South African cohort","volume":"12","author":"Boulle A","year":"2007","journal-title":"Antiviral Therapy"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3181b8f26e"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/1478-4491-8-8"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3181988375"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/1758-2652-12-23"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e318033ffa1"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-10-229"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)16597-5"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trstmh.2009.02.012"},{"key":"e_1_2_6_12_1","unstructured":"Ministry of Health and Social Welfare & National AIDS Commission(2009)National HIV and AIDS Estimates for Lesotho 2009.http:\/\/www.nas.org.ls\/documents\/default.php(accessed September 5 2010)."},{"key":"e_1_2_6_13_1","volume-title":"National Anti\u2010retroviral Treatment Guidelines 2004","author":"Ministry of Health and Social Welfare of Lesotho","year":"2004"},{"key":"e_1_2_6_14_1","volume-title":"National Antiretroviral Treatment Guidelines 2007","author":"Ministry of Health and Social Welfare of Lesotho, M.O.H.S.W.","year":"2007"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-9-5"},{"key":"e_1_2_6_16_1","volume-title":"Annual Report on the National Response to HIV and AIDS \u2013 Reporting Period January to December 2009","author":"National AIDS Commission","year":"2010"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60894-X"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3181eb5edb"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000163"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2009.00731.x"},{"key":"e_1_2_6_21_1","unstructured":"UNAIDS(2010) Global Report ISBN 978\u201092\u20109173\u2010871\u20107. 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