BACKGROUND: Antiretroviral treatment (ART) coverage in Myanmar is well below average. This study describes retention and baseline predictors of prognosis from the largest ART program in the country. METHODS: A cohort analysis of adult patients who initiated ART during 2003-2007 was conducted, with follow-up until the end of 2009. The primary outcome was attrition [death plus losses to follow-up (LTF)]. Baseline variables were assessed as potential risk factors. The cumulative probabilities of death, LTF, and attrition up to 5 years were described using Kaplan-Meier estimates. Cox regression was used to calculate hazard ratios of attrition, overall and separately for 2 time periods on ART: 1-6 and 7-36 months. RESULTS: A total of 5963 adults enrolled in the program, providing 17,581 person-years of follow-up. Median age at baseline was 33 years [interquartile range (IQR): 28-38], 61% were men, 45% were in World Health Organization stage IV, and the median CD4 count was 71 cells per cubic millimeter (IQR: 29-164). There were 821 (13.8%) deaths and 389 (6.5%) LTF over the study period, with a 72% probability of being retained in care in the 5-year cohort. Double the rate of loss was contributed by death compared with LTF, and attrition was almost 4 times higher in the period 1-6 months compared with 7-36 months. In the multivariable analyses of the program overall, older age [adjusted hazard ratio (aHR): 1.56, 95% confidence interval (CI): 1.25 to 1.94], being male (aHR: 1.52, 95% CI: 1.25 to 1.85), World Health Organization stage IV (aHR: 1.44, 95% CI: 1.19 to 1.74), and body mass index <16 kg/m² (aHR: 2.13, 95% CI: 1.71 to 2.66) were independently predictive of attrition. CONCLUSIONS: The excellent retention over >6 years in this large cohort demonstrates that ART delivery at the primary care level in Myanmar is feasible and should encourage support for further ART expansion in the country.
BACKGROUND: Antiretroviral treatment (ART) coverage in Myanmar is well below average. This study describes retention and baseline predictors of prognosis from the largest ART program in the country. METHODS: A cohort analysis of adult patients who initiated ART during 2003-2007 was conducted, with follow-up until the end of 2009. The primary outcome was attrition [death plus losses to follow-up (LTF)]. Baseline variables were assessed as potential risk factors. The cumulative probabilities of death, LTF, and attrition up to 5 years were described using Kaplan-Meier estimates. Cox regression was used to calculate hazard ratios of attrition, overall and separately for 2 time periods on ART: 1-6 and 7-36 months. RESULTS: A total of 5963 adults enrolled in the program, providing 17,581 person-years of follow-up. Median age at baseline was 33 years [interquartile range (IQR): 28-38], 61% were men, 45% were in World Health Organization stage IV, and the median CD4 count was 71 cells per cubic millimeter (IQR: 29-164). There were 821 (13.8%) deaths and 389 (6.5%) LTF over the study period, with a 72% probability of being retained in care in the 5-year cohort. Double the rate of loss was contributed by death compared with LTF, and attrition was almost 4 times higher in the period 1-6 months compared with 7-36 months. In the multivariable analyses of the program overall, older age [adjusted hazard ratio (aHR): 1.56, 95% confidence interval (CI): 1.25 to 1.94], being male (aHR: 1.52, 95% CI: 1.25 to 1.85), World Health Organization stage IV (aHR: 1.44, 95% CI: 1.19 to 1.74), and body mass index <16 kg/m² (aHR: 2.13, 95% CI: 1.71 to 2.66) were independently predictive of attrition. CONCLUSIONS: The excellent retention over >6 years in this large cohort demonstrates that ART delivery at the primary care level in Myanmar is feasible and should encourage support for further ART expansion in the country.
Authors: Nancy H Puttkammer; Steven B Zeliadt; Janet G Baseman; Rodney Destiné; Jean Wysler Domerçant; Nancy Rachel Labbé Coq; Nernst Atwood Raphael; Kenneth Sherr; Mary Tegger; Krista Yuhas; Scott Barnhart Journal: Rev Panam Salud Publica Date: 2014-10
Authors: Nicole L De La Mata; Penh S Ly; Kinh V Nguyen; Tuti P Merati; Thuy T Pham; Man P Lee; Jun Y Choi; Jeremy Ross; Matthew G Law; Oon T Ng Journal: J Acquir Immune Defic Syndr Date: 2017-04-15 Impact factor: 3.731
Authors: Aye Thida; Sai Thein Than Tun; Sai Ko Ko Zaw; Andrew A Lover; Philippe Cavailler; Jennifer Chunn; Mar Mar Aye; Par Par; Kyaw Win Naing; Kaung Nyunt Zan; Myint Shwe; Thar Tun Kyaw; Zaw Htoon Waing; Philippe Clevenbergh Journal: PLoS One Date: 2014-09-30 Impact factor: 3.240
Authors: Sarah W Beckham; Chris Beyrer; Peter Luckow; Meg Doherty; Eyerusalem K Negussie; Stefan D Baral Journal: J Int AIDS Soc Date: 2016-11-08 Impact factor: 5.396
Authors: Dam Anh Tran; Anh Duc Ngo; Anthony Shakeshaft; David P Wilson; Christopher Doran; Lei Zhang Journal: PLoS One Date: 2013-09-16 Impact factor: 3.240
Authors: Ibrahim Dalhatu; Dennis Onotu; Solomon Odafe; Oseni Abiri; Henry Debem; Simon Agolory; Ray W Shiraishi; Andrew F Auld; Mahesh Swaminathan; Kainne Dokubo; Evelyn Ngige; Chukwuemeka Asadu; Emmanuel Abatta; Tedd V Ellerbrock Journal: PLoS One Date: 2016-11-09 Impact factor: 3.240