Decentralization in this regard has been markedly instrumental, also in improving the expansion of HIV services to lower-level health delivery units. Patients with HIV in developing countries have incurred substantial clinical benefits owing to the great efforts in the deployment of antiretroviral therapy (ART). The higher rate of DR at Saint-Louis (12.9% vs 2.7% in Dakar) was associated with nevirapine-based therapies (OR = 5.13, P = .035). In stratification analyses by site, higher rate of VF at Saint-Louis (20.5% vs 4.0% in Dakar) was associated with nevirapine-based therapies (OR = 3.34, P = .038), self-reported missing doses (OR = 3.30, P = .029), and medical appointments (OR = 2.91, P = .039) in the last 1 and 12 months(s), respectively. Strong correlates of DR also included Saint-Louis ( P < .009), CD4 < 350 cells/mm 3 ( P <. 001), and nevirapine-based therapies (comparator: efavirenz-based therapies P < .027). The adjusted odds of VF was significantly associated with the decentralized clinic site ( P < .001) and CD4 < 350 cells/mm 3 ( P < .006). The pattern of mutations did not always correspond to the ongoing treatment. Of the 27 viraemic isolates successfully genotyped, 20 (74.1%) carried DR mutations most frequent were M184VI (55.6%), K103N (37.1%), thymidine analog mutations (29.6%), Y181CY (22.2%). Failing and non-failing patients had comparable median time on ART (69.5 vs 64.0 months P = .46, Mann–Whitney U-test). Of the 278 adults on EFV-/NVP-based regimens, 32 (11.5% ) experienced VF.
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