UNLABELLED: OBJECTIVE To analyse survival and retention rates of the Tanzanian care and treatment programme. 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.
UNLABELLED: OBJECTIVE To analyse survival and retention rates of the Tanzanian care and treatment programme. 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: Elvin H Geng; Thomas A Odeny; Rita E Lyamuya; Alice Nakiwogga-Muwanga; Lameck Diero; Mwebesa Bwana; Winnie Muyindike; Paula Braitstein; Geoffrey R Somi; Andrew Kambugu; Elizabeth A Bukusi; Megan Wenger; Kara K Wools-Kaloustian; David V Glidden; Constantin T Yiannoutsos; Jeffrey N Martin Journal: Lancet HIV Date: 2015-01-28 Impact factor: 12.767
Authors: Sandra I McCoy; Prosper F Njau; Carolyn Fahey; Ntuli Kapologwe; Suneetha Kadiyala; Nicholas P Jewell; William H Dow; Nancy S Padian Journal: AIDS Date: 2017-03-27 Impact factor: 4.177
Authors: George Alemnji; Peter Fonjungo; Barbara Van Der Pol; Trevor Peter; Rami Kantor; John Nkengasong Journal: AIDS Patient Care STDS Date: 2014-04-17 Impact factor: 5.078
Authors: Nora M McCormick; Nan Li; David Sando; Aisa Muya; Karim P Manji; Rodrick Kisenge; Christopher Duggan; Guerino Chalamilla; Wafaie W Fawzi; Donna Spiegelman Journal: J Acquir Immune Defic Syndr Date: 2015-11-01 Impact factor: 3.731
Authors: Amin S Hassan; Shalton M Mwaringa; Kennedy K Ndirangu; Eduard J Sanders; Tobias F Rinke de Wit; James A Berkley Journal: BMC Public Health Date: 2015-05-10 Impact factor: 3.295
Authors: Abela Mpobela Agnarson; Francis Levira; Honorati Masanja; Anna Mia Ekström; Anna Thorson Journal: PLoS One Date: 2013-01-16 Impact factor: 3.240
Authors: Serena P Koenig; Alexandra Bornstein; Karine Severe; Elizabeth Fox; Jessy G Dévieux; Patrice Severe; Patrice Joseph; Adias Marcelin; Dgndy Alexandre Bright; Ngoc Pham; Pierre Cremieux; Jean William Pape Journal: PLoS One Date: 2015-11-12 Impact factor: 3.240