{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:22:43Z","timestamp":1771546963837,"version":"3.50.1"},"reference-count":42,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,2,6]],"date-time":"2020-02-06T00:00:00Z","timestamp":1580947200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001713","name":"European and Developing Countries Clinical Trials Partnership","doi-asserted-by":"publisher","award":["IP.07.33011.004"],"award-info":[{"award-number":["IP.07.33011.004"]}],"id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Early identification of confirmed virological failure is paramount to avoid accumulation of drug resistance in patients on antiretroviral therapy (ART). Scale\u2010up of HIV\u2010RNA monitoring in Africa and timely switch to second\u2010line regimens are challenged.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A WHO adapted confirmed virological treatment screening algorithm (HIV\u2010RNA screening, enhanced adherence counselling, confirmatory HIV\u2010RNA testing) was evaluated in HIV\u2010infected patients on first\u2010line ART from Tanzania. The main endpoints included viral resuppression and virological failure rates, retention and turnaround time of the screening algorithm until second\u2010line ART initiation. Secondary endpoints included risk factors for virological treatment failure and patterns of genotypic drug resistance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>HIV\u2010RNA &gt;1000 copies\/ml at first screening was detected in 58\/356 (16.3%) patients (median time\u2010on\u2010treatment 6.3\u00a0years, 25% immunological treatment failure). Adjusted risk factors for virological failure were age &lt;30\u00a0years (RR 5.2 [95% CI: 2.5\u201310.8]), years on ART \u22653\u00a0years (RR 3.0 [1.0\u20138.9]), CD4\u2010counts &lt;200 cells\/\u00b5l (RR 9.3 [4.0\u201321.8]) and poor self\u2010reported treatment adherence (RR 2.0 [1.2\u20133.4]). Resuppression of HIV\u2010RNA &lt;1000 copies\/ml was observed in 5\/50 (10%) cases after enhanced adherence counselling. Confirmatory testing within 3\u00a0months was performed in only 46.6% and switch to second\u2010line ART within 6\u00a0months in 60.4% of patients. Major NNRTI\u2010mutation were detected in all of 30 patients, NRTI mutations in 96.7% and \u22653 thymidine\u2010analogue mutations in 40%. No remaining NRTI options were predicted in 57% and limited susceptibility in 23% of patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We observed low levels of viral resuppression following adherence counselling, associated with high levels of accumulated drug resistance. High visit burden and turnaround times for confirmed virological failure diagnosis further delayed switching to second\u2010line treatment which could be improved using novel point\u2010of\u2010care viral load monitoring systems.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13373","type":"journal-article","created":{"date-parts":[[2020,1,27]],"date-time":"2020-01-27T10:04:14Z","timestamp":1580119454000},"page":"579-589","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["High turnaround times and low viral resuppression rates after reinforced adherence counselling following a confirmed virological failure diagnostic algorithm in HIV\u2010infected patients on first\u2010line antiretroviral therapy from Tanzania"],"prefix":"10.1111","volume":"25","author":[{"given":"Arne","family":"Kroidl","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and Tropical Medicine Medical Center of the University of Munich Munich Germany"},{"name":"German Center for Infection Research Partner site Munich Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tassilo","family":"Burger","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Tropical Medicine Medical Center of the University of Munich Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agatha","family":"Urio","sequence":"additional","affiliation":[{"name":"NIMR\u2010Mbeya Medical Research Center Mbeya Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roki","family":"Mugeniwalwo","sequence":"additional","affiliation":[{"name":"NIMR\u2010Mbeya Medical Research Center Mbeya Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jimson","family":"Mgaya","sequence":"additional","affiliation":[{"name":"NIMR\u2010Mbeya Medical Research Center Mbeya Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faith","family":"Mlagalila","sequence":"additional","affiliation":[{"name":"NIMR\u2010Mbeya Medical Research Center Mbeya Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Hoelscher","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Tropical Medicine Medical Center of the University of Munich Munich Germany"},{"name":"German Center for Infection Research Partner site Munich Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"D\u00e4umer","sequence":"additional","affiliation":[{"name":"Institute of Immunology and Genetics Kaiserslautern Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omar","family":"Salehe","sequence":"additional","affiliation":[{"name":"Mbeya Zonal Referral Hospital Mbeya Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Sangare","sequence":"additional","affiliation":[{"name":"Mbeya Zonal Referral Hospital Mbeya Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tessa","family":"Lennemann","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Tropical Medicine Medical Center of the University of Munich Munich Germany"},{"name":"NIMR\u2010Mbeya Medical Research Center Mbeya Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucas","family":"Maganga","sequence":"additional","affiliation":[{"name":"NIMR\u2010Mbeya Medical Research Center Mbeya Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,2,6]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"UNAIDS.UNAIDS data 2018. 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