{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:55:04Z","timestamp":1791222904913,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2016,7,7]],"date-time":"2016-07-07T00:00:00Z","timestamp":1467849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["674\u2010A\u201012\u201000029"],"award-info":[{"award-number":["674\u2010A\u201012\u201000029"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>In resource\u2010limited settings, where genotypic drug resistance testing is rarely performed and poor adherence is the most common reason for treatment failure, programmatic approaches to handling treatment failure are essential. This study was performed to describe one such approach to adherence optimisation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a single\u2010arm study of patients on second\u2010line protease inhibitor (<jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content>)\u2010based antiretroviral therapy (<jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>) with a <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u20101 <jats:styled-content style=\"fixed-case\">RNA<\/jats:styled-content> \u2265400 copies\/ml in Johannesburg, South Africa, between 1 March 2012 and 1 December 2013. Patients underwent enhanced adherence counselling. Those with improved adherence and a repeat viral load of &gt;1000 copies\/ml underwent <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u20101 drug resistance testing. We describe results using simple proportions and 95% confidence intervals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 400 patients who underwent targeted adherence counselling after an elevated viral load on second\u2010line <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>, 388 (97%) underwent repeat viral load testing. Most of these (<jats:italic>n<\/jats:italic> = 249; 64%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 59\u201369) resuppressed (&lt;400 copies\/ml) on second line. By the end of follow\u2010up (1 March 2014), among the 139 (36%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 31\u201341%), who did not initially resuppress after being targeted, 106 had a viral load &gt;400 copies\/ml, 11 switched to third line, 5 were awaiting third line, 4 had died and 13 were lost to follow\u2010up. Among the unsuppressed, 48 successfully underwent resistance testing with some resistance detected in most (41\/48).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Most (64%) second\u2010line treatment failure in this clinic is related to adherence and can be overcome with careful adherence support. Controlled interventions are needed to determine what the optimal approach is to improving second\u2010line outcomes and reducing the need for third\u2010line <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12741","type":"journal-article","created":{"date-parts":[[2016,7,7]],"date-time":"2016-07-07T06:58:07Z","timestamp":1467874687000},"page":"1131-1137","source":"Crossref","is-referenced-by-count":60,"title":["Intensive adherence counselling for HIV\u2010infected individuals failing second\u2010line antiretroviral therapy in Johannesburg, South Africa"],"prefix":"10.1111","volume":"21","author":[{"given":"Matthew P.","family":"Fox","sequence":"first","affiliation":[{"name":"Health Economics and Epidemiology Research Office Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"},{"name":"Department of Global Health Boston University School of Public Health Boston MA USA"},{"name":"Department 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Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prudence","family":"Ive","sequence":"additional","affiliation":[{"name":"Clinical HIV Research Unit Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Spencer","sequence":"additional","affiliation":[{"name":"Right to Care Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sello","family":"Mashamaite","sequence":"additional","affiliation":[{"name":"Right to Care Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadiyya","family":"Sheik","sequence":"additional","affiliation":[{"name":"Task Applied Science Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Jonker","sequence":"additional","affiliation":[{"name":"Witkoppen Health and Welfare Center Johannesburg South 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