| Outcomes of antiretroviral treatment programs in rural Southern Africa. | |
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MedLine Citation:
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PMID: 22067665 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: Data on outcomes of antiretroviral treatment (ART) programs in rural sub-Saharan African are scarce. We describe early losses and long-term outcomes in six rural programs in Southern Africa with limited access to viral load monitoring and second-line ART. METHODS: Patients aged ≥16 years starting ART in two programs each in Zimbabwe, Mozambique and Lesotho were included. We evaluated risk factors for no follow-up after starting ART and mortality and loss to follow-up (LTFU) over 3 years of ART, using logistic regression and competing risk models. Odds ratios and sub-distribution hazard ratios, adjusted for gender, age category, CD4 category and WHO stage at start of ART are reported. RESULTS: Among 7,725 patients, 449 (5.8%) did not return after initiation of ART. Over 9,575 person-years, 698 (9.6%) of those with at least one follow-up visit died and 1,319 (18.1%) were LTFU. At 3 years the cumulative incidence of death and LTFU were 12.5% (11.5-13.5%) and 25.4% (24.0-26.9%), respectively, with important differences between countries: in Zimbabwe 75.1% (72.8-77.3%) were alive and on ART at 3 years compared to 55.4% (52.8-58.0%) in Lesotho and 51.6% (48.0-55.2%) in Mozambique. In all settings young age and male gender predicted LTFU, whereas advanced clinical stage and low baseline CD4 counts predicted death. CONCLUSIONS: In African ART programs with limited access to second-line treatment, mortality and LTFU are high in the first 3 years of ART. Low retention in care is a major threat to the sustainability of ART delivery in Southern Africa, particularly in rural sites. |
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Authors:
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Gilles Wandeler; Olivia Keiser; Karolin Pfeiffer; Sabrina Pestilli; Christiane Fritz; Niklaus D Labhardt; Franzisco Mbofana; Robert Mudyiradima; Jan Emmel; Matthias Egger; Jochen Ehmer; |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-11-7 |
Journal Detail:
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Title: Journal of acquired immune deficiency syndromes (1999) Volume: - ISSN: 1944-7884 ISO Abbreviation: - Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-11-9 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100892005 Medline TA: J Acquir Immune Defic Syndr Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland 2Infectious Diseases Clinic, Bern University Hospital, Bern, Switzerland 3SolidarMed, Lucerne, Switzerland 4Ministry of Health, Mozambique 5Ministry of Health, Zimbabwe. |
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