This application will investigate the success of antiretroviral treatment in women of developing Sub-Saharan African countries, Uganda and Zimbabwe. Our hypothesis for this pilot study will be that women enrolled in clinical trials that provide antiretroviral (ARV) drugs will have better treatment outcomes than women who must purchase the same ARV regimens. Even though both groups will be monitored using the same tests (viral load, CD4 cell counts, drug resistance) and by the same group of physicians, the role(s) of socioeconomic factors, of initial education about HIV treatment/care, and of adherence will likely have greater effect in the """"""""ARV self-purchased"""""""" group than in the """"""""ARV clinical trial"""""""" group. Understanding these differences will have a significant impact on how to expand ARV treatment and care in developing countries, to avoid treatment failures, and to prevent major public health issues such as the spread of drug resistance. ? We have proposed three specific aims to study the factors relating to ARV treatment failure of women in Uganda and Zimbabwe. These two sites were selected based on differences in socioeconomic factors and HIV-1 subtypes responsible for infections. However, the greater differences, regardless of study site, may be related to patients receiving ARVs as part of a clinical study or those who must purchased ARVs from personal income.
Specific Aim 1 is to analyze the clinical outcomes of patients treated with a specific ARV regimen as part of clinical study or self purchased in resource-limited settings.
Specific Aim 2 is to monitor the emergence of ARV resistance in treated Ugandan and Zimbabwean women and to determine if subtypes alter patterns or appearance rates of drug resistant mutations.
Specific Aim 3 is to investigate issues of adherence and socioeconomic factors that lead to ARV treatment failure in HIV-infected Zimbabwean and Ugandan women ? ?
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