Document Detail


Low mortality risk but high loss to follow-up among patients in the Tanzanian national HIV care and treatment programme.
MedLine Citation:
PMID:  22296265     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
METHODS: Routine patient-level data were available from 101 of 909 clinics. Kaplan-Meier probabilities of mortality and attrition after ART initiation were calculated. Mortality risks were corrected for biases from loss to follow-up using Egger's nomogram. Smoothed hazard rates showed mortality and attrition peaks. Cox regression identified factors associated with death and attrition. Median CD4 counts were calculated at 6 month intervals.
RESULTS: In 88,875 adults, 18% were lost to follow up 12 months after treatment initiation, and 36% after 36 months. Cumulative mortality reached 10% by 12 months (15% after correcting for loss to follow-up) and 14% by 36 months. Mortality and attrition rates both peaked within the first six months, and were higher among males, those under 45 kg and those with CD4 counts below 50 cells/μl at ART initiation. In the first year on ART, median CD4 count increased by 126 cells/μl, with similar changes in both sexes.
CONCLUSION: Earlier diagnoses through expanded HIV testing may reduce high mortality and attrition rates if combined with better patient tracing systems. Further research is needed to explore reasons for attrition.
Authors:
G Somi; S C Keogh; J Todd; B Kilama; A Wringe; J van den Hombergh; K Malima; R Josiah; M Urassa; R Swai; B Zaba
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Publication Detail:
Type:  Journal Article     Date:  2012-02-01
Journal Detail:
Title:  Tropical medicine & international health : TM & IH     Volume:  17     ISSN:  1365-3156     ISO Abbreviation:  Trop. Med. Int. Health     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-09-06     Completed Date:  2012-12-03     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  9610576     Medline TA:  Trop Med Int Health     Country:  England    
Other Details:
Languages:  eng     Pagination:  497-506     Citation Subset:  IM    
Copyright Information:
© 2012 Blackwell Publishing Ltd.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Anti-Retroviral Agents / therapeutic use
Antiretroviral Therapy, Highly Active / statistics & numerical data*
Attitude to Health
Drug Administration Schedule
Female
Follow-Up Studies
HIV Infections / drug therapy*,  mortality*
Humans
Lost to Follow-Up*
Male
Middle Aged
Patient Compliance / psychology,  statistics & numerical data*
Patient Dropouts / psychology,  statistics & numerical data*
Proportional Hazards Models
Risk Assessment
Risk Factors
Severity of Illness Index*
Survival Analysis
Survival Rate
Tanzania / epidemiology
Young Adult
Grant Support
ID/Acronym/Agency:
G0902143//Medical Research Council
Chemical
Reg. No./Substance:
0/Anti-Retroviral Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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