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While the adherence proportion required to sustain viral suppression may decline over time, the goal of near perfect adherence should remain unchanged.
Because adherence proportion cannot be randomly assigned as an intervention, we relied on a marginal structural model and targeted maximum likelihood estimation of the causal effects of adherence on viral suppression at each time point.
We stratified subject-months by corresponding duration of suppression and then estimated the probability of virologic failure setting the adherence proportion to be in the ranges (0 49%, 50 74%, 75 89%, and 90 100%).
Last, we modeled the effect of copayment on adherence (proportion of days covered) to each new medication.
Figure 1 includes definitions of utilization metrics, including persistence, medication possession ratio (MPR), adherence, proportion of days covered (PDC) and time to therapy discontinuation.
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Adherence proportions were analyzed with the non-parametric Cochran's Q test, using cut-off values of VTe ≤ 8.0 mL kg.
We considered the causal relative risk, comparing the effect of different adherence proportions on the probability of virologic failure.
We first estimated the causal effect of different adherence proportions on the probability of virologic failure, conditioned on duration of continuous viral suppression (Figure 1).
Median adherence proportions in cross-sectional studies were 74.3% (Range 25 88%) for papers alone and 73.6% when the three conference abstracts were added.
Based on univariate regression analyses, participants who had longer duration of suppression also had higher CD4+ counts, higher CD4+ nadir, and higher cumulative average adherence proportions.
There was a statistically significant positive association demonstrated between overall financial livelihood and adherence proportions (exponentiated beta coefficient = 1.53, 95% CI: 1.03 2.29, p = 0.04).
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