Details:

Alternative Title:
BMC Public Health
Publisher's site:
http://dx.doi.org/10.1186/1471-2458-9-290
Personal Author:
Amuron, Barbara ; Namara, Geoffrey ; Birungi, Josephine ; Nabiryo, Christine ; Levin, Jonathan ; ... More +
Amuron, Barbara ; Namara, Geoffrey ; Birungi, Josephine ; Nabiryo, Christine ; Levin, Jonathan ; Grosskurth, Heiner ; Coutinho, Alex ; Jaffar, Shabbar Less -
Description:
Background

In many HIV programmes in Africa, patients are assessed clinically and prepared for antiretroviral treatment over a period of 4–12 weeks. Mortality rates following initiation of ART are very high largely because patients present late with advanced disease. The rates of mortality and retention during the pre-treatment period are not well understood. We conducted an observational study to determine these rates.

Methods

HIV-infected subjects presenting at The AIDS Support Clinic in Jinja, SE Uganda, were assessed for antiretroviral therapy (ART). Eligible subjects were given information and counselling in 3 visits done over 4–6 weeks in preparation for treatment. Those who did not complete screening were followed-up at home. Survival analysis was done using poisson regression.

Results

4321 HIV-infected subjects were screened of whom 2483 were eligible for ART on clinical or immunological grounds. Of these, 637 (26%) did not complete screening and did not start ART. Male sex and low CD4 count were associated independently with not completing screening. At follow-up at a median 351 days, 181 (28%) had died, 189 (30%) reported that they were on ART with a different provider, 158 (25%) were alive but said they were not on ART and 109 (17%) were lost to follow-up. Death rates (95% CI) per 100 person-years were 34 (22, 55) (n.18) within one month and 37 (29, 48) (n.33) within 3 months. 70/158 (44%) subjects seen at follow-up said they had not started ART because they could not afford transport.

Conclusion

About a quarter of subjects eligible for ART did not complete screening and pre-treatment mortality was very high even though patients in this setting were well informed. For many families, the high cost of transport is a major barrier preventing access to ART.


Subject:
[+]
Adult
Anti-HIV Agents
CD4 Lymphocyte Count
Female
Follow-Up Studies
HIV Infections
Humans
Male

Source:
BMC Public Health. 2009; 9:290.
Pubmed ID:
19671185
Pubmed Central ID:
PMC2734853
Document Type:
Journal Article
Funding:
1U01-PS000065-01/PS/NCHHSTP CDC HHS/United States ; G0700837/Medical Research Council/United Kingdom ; Medical Research Council/United Kingdom
1U01-PS000065-01/PS/NCHHSTP CDC HHS/United States ; G0700837/Medical Research Council/United Kingdom ; Medical Research Council/United Kingdom Less -
Place as Subject:
Uganda
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:64627d054249e878d1ad6f04a15e98c91f60d10ea2a2f108f3db696b9d4a8751
File Type:

Supporting Files

• 	1471-2458-9-290-1.gif	gif
  	1471-2458-9-290-1.jpg	jpeg
  	1471-2458-9-290.nxml	txt
  	license.txt	txt

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