Mortality in an antiretroviral therapy programme in Jinja, south-east Uganda: a prospective cohort study
Open Access
- 22 October 2011
- journal article
- Published by Springer Science and Business Media LLC in AIDS Research and Therapy
- Vol. 8 (1), 39
- https://doi.org/10.1186/1742-6405-8-39
Abstract
Background There have been few reports of long-term survival of HIV-infected patients on antiretroviral therapy (ART) in Africa managed under near normal health service conditions. Methods Participants starting ART between February 2005 and December 2006 in The AIDS Support (TASO) clinic in Jinja, Uganda, were enrolled into a cluster-randomised trial of home versus facility-based care and followed up to January 2009. The trial was integrated into normal service delivery with patients managed by TASO staff according to national guidelines. Rates of survival, virological failure, hospital admissions and CD4 count over time were similar between the two arms. Data for the present analysis were analysed using Cox regression analyses. Results 1453 subjects were enrolled with baseline median count of 108 cells/μl. Over time, 119 (8%) withdrew and 34 (2%) were lost to follow-up. 197/1453 (14%) died. Mortality rates (95% CI) per 100 person-years were 11.8 (10.1, 13.8) deaths in the first year and 2.4 (1.8, 3.2) deaths thereafter. The one, two and three year survival probabilities (95% CI) were 0.89 (0.87 - 0.91), 0.86 (0.84 - 0.88) and 0.85 (0.83 - 0.87) respectively. Low baseline CD4 count, low body weight, advanced clinical condition (WHO stages III and IV), not being on cotrimoxazole prophylaxis and male gender were associated independently with increased mortality. Tuberculosis, cryptococcal meningitis and diarrhoeal disease were estimated to be major causes of death. Conclusion Practical and affordable interventions are needed to enable earlier initiation of ART and to reduce mortality risk among those who present late for treatment with advanced disease.Keywords
This publication has 14 references indexed in Scilit:
- Retention in HIV Care between Testing and Treatment in Sub-Saharan Africa: A Systematic ReviewPLoS Medicine, 2011
- Men and antiretroviral therapy in Africa: our blind spotTropical Medicine & International Health, 2011
- Patient retention in antiretroviral therapy programs up to three years on treatment in sub‐Saharan Africa, 2007–2009: systematic reviewTropical Medicine & International Health, 2010
- Rates of virological failure in patients treated in a home-based versus a facility-based HIV-care model in Jinja, southeast Uganda: a cluster-randomised equivalence trialThe Lancet, 2010
- Routine versus clinically driven laboratory monitoring of HIV antiretroviral therapy in Africa (DART): a randomised non-inferiority trialThe Lancet, 2009
- Adherence to antiretroviral therapy in Africa: how high is it really?Tropical Medicine & International Health, 2008
- Integrating research into routine service delivery in an antiretroviral treatment programme: lessons learnt from a cluster randomized trial comparing strategies of HIV care in Jinja, UgandaTropical Medicine & International Health, 2008
- A Cluster-Randomised Trial to Compare Home-Based with Health Facility-Based Antiretroviral Treatment in Uganda: Study Design and Baseline FindingsThe Open AIDS Journal, 2007
- Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countriesThe Lancet, 2006
- The use of fractional polynomials to model continuous risk variables in epidemiologyInternational Journal of Epidemiology, 1999