BACKGROUND: During 2004-2013 in Mozambique, 455,600 HIV-positive adults (≥15 years old) initiated antiretroviral therapy (ART). We evaluated trends in patient characteristics and outcomes during 2004-2013, outcomes of universal treatment for pregnant women (Option B+) implemented since 2013, and effect on outcomes of distributing ART to stable patients through Community ART Support Groups (CASG) since 2010. METHODS: Data for 306,335 adults starting ART during 2004-2013 at 170 ART facilities were analyzed. Mortality and loss to follow-up (LTFU) were estimated using competing risks models. Outcome determinants were estimated using proportional hazards models, including CASG participation as a time-varying covariate. RESULTS: Compared with ART enrollees in 2004, enrollees in 2013 were more commonly female (55% vs. 73%), more commonly pregnant if female (<1% vs. 30%), and had a higher median baseline CD4 count (139 vs. 235/μL). During 2004-2013, observed 6-month mortality declined from 7% to 2% but LTFU increased from 24% to 30%. Pregnant women starting ART with CD4 count >350/μL and WHO stage I/II under Option B+ guidelines in 2013 had low 6-month mortality (0.1%) but high 6-month LTFU (38%). During 2010-2013, 6766 patients joined CASGs. In multivariable analysis, compared with nonparticipation in CASG, CASG participation was associated with 35% lower LTFU but similar mortality. CONCLUSIONS: Initiation of ART at earlier disease stages in later calendar years might explain observed declines in mortality. Retention interventions are needed to address trends of increasing LTFU overall and the high LTFU among Option B+ pregnant women specifically. Further expansion of CASG could help reduce LTFU.
BACKGROUND: During 2004-2013 in Mozambique, 455,600 HIV-positive adults (≥15 years old) initiated antiretroviral therapy (ART). We evaluated trends in patient characteristics and outcomes during 2004-2013, outcomes of universal treatment for pregnant women (Option B+) implemented since 2013, and effect on outcomes of distributing ART to stable patients through Community ART Support Groups (CASG) since 2010. METHODS: Data for 306,335 adults starting ART during 2004-2013 at 170 ART facilities were analyzed. Mortality and loss to follow-up (LTFU) were estimated using competing risks models. Outcome determinants were estimated using proportional hazards models, including CASG participation as a time-varying covariate. RESULTS: Compared with ART enrollees in 2004, enrollees in 2013 were more commonly female (55% vs. 73%), more commonly pregnant if female (<1% vs. 30%), and had a higher median baseline CD4 count (139 vs. 235/μL). During 2004-2013, observed 6-month mortality declined from 7% to 2% but LTFU increased from 24% to 30%. Pregnant women starting ART with CD4 count >350/μL and WHO stage I/II under Option B+ guidelines in 2013 had low 6-month mortality (0.1%) but high 6-month LTFU (38%). During 2010-2013, 6766 patients joined CASGs. In multivariable analysis, compared with nonparticipation in CASG, CASG participation was associated with 35% lower LTFU but similar mortality. CONCLUSIONS: Initiation of ART at earlier disease stages in later calendar years might explain observed declines in mortality. Retention interventions are needed to address trends of increasing LTFU overall and the high LTFU among Option B+ pregnant women specifically. Further expansion of CASG could help reduce LTFU.
Authors: James T Pfeiffer; Manuel Napúa; Bradley H Wagenaar; Falume Chale; Roxanne Hoek; Mark Micek; João Manuel; Cathy Michel; Jessica Greenberg Cowan; James F Cowan; Sarah Gimbel; Kenneth Sherr; Stephen Gloyd; Rachel R Chapman Journal: J Acquir Immune Defic Syndr Date: 2017-11-01 Impact factor: 3.731
Authors: Brandon A Knettel; Cody Cichowitz; James Samwel Ngocho; Elizabeth T Knippler; Lilian N Chumba; Blandina T Mmbaga; Melissa H Watt Journal: J Acquir Immune Defic Syndr Date: 2018-04-15 Impact factor: 3.731
Authors: Cody Cichowitz; Festo Mazuguni; Linda Minja; Prosper Njau; Gretchen Antelman; James Ngocho; Brandon A Knettel; Melissa H Watt; Blandina T Mmbaga Journal: AIDS Behav Date: 2019-07
Authors: Andrew F Auld; Ray W Shiraishi; Ikwo Oboho; Christine Ross; Moses Bateganya; Valerie Pelletier; Jacob Dee; Kesner Francois; Nirva Duval; Mayer Antoine; Chris Delcher; Gracia Desforges; Mark Griswold; Jean Wysler Domercant; Nadjy Joseph; Varough Deyde; Yrvel Desir; Joelle Deas Van Onacker; Ermane Robin; Helen Chun; Isaac Zulu; Ishani Pathmanathan; E Kainne Dokubo; Spencer Lloyd; Rituparna Pati; Jonathan Kaplan; Elliot Raizes; Thomas Spira; Kiren Mitruka; Aleny Couto; Eduardo Samo Gudo; Francisco Mbofana; Melissa Briggs; Charity Alfredo; Carla Xavier; Alfredo Vergara; Ndapewa Hamunime; Simon Agolory; Gram Mutandi; Naemi N Shoopala; Souleymane Sawadogo; Andrew L Baughman; Adebobola Bashorun; Ibrahim Dalhatu; Mahesh Swaminathan; Dennis Onotu; Solomon Odafe; Oseni Omomo Abiri; Henry H Debem; Hank Tomlinson; Velephi Okello; Peter Preko; Trong Ao; Caroline Ryan; George Bicego; Peter Ehrenkranz; Harrison Kamiru; Harriet Nuwagaba-Biribonwoha; Gideon Kwesigabo; Angela A Ramadhani; Kahemele Ng'wangu; Patrick Swai; Mohamed Mfaume; Ramadhani Gongo; Deborah Carpenter; Timothy D Mastro; Carol Hamilton; Julie Denison; Fred Wabwire-Mangen; Olivier Koole; Kwasi Torpey; Seymour G Williams; Robert Colebunders; Julius N Kalamya; Alice Namale; Michelle R Adler; Bridget Mugisa; Sundeep Gupta; Sharon Tsui; Eric van Praag; Duc B Nguyen; Sheryl Lyss; Yen Le; Abu S Abdul-Quader; Nhan T Do; Modest Mulenga; Sebastian Hachizovu; Owen Mugurungi; Beth A Tippett Barr; Elizabeth Gonese; Tsitsi Mutasa-Apollo; Shirish Balachandra; Stephanie Behel; Trista Bingham; Duncan Mackellar; David Lowrance; Tedd V Ellerbrock Journal: MMWR Morb Mortal Wkly Rep Date: 2017-06-02 Impact factor: 17.586
Authors: Andrew F Auld; Ermane G Robin; Ray W Shiraishi; Jacob Dee; Mayer Antoine; Yrvel Desir; Gracia Desforges; Chris Delcher; Nirva Duval; Nadjy Joseph; Kesner Francois; Mark Griswold; Jean Wysler Domercant; Yves Anthony Patrice Joseph; Joelle Deas Van Onacker; Varough Deyde; David W Lowrance Journal: Am J Trop Med Hyg Date: 2017-10 Impact factor: 2.345