Mortality and loss-to-follow-up during the pre-treatment period in an antiretroviral therapy programme under normal health service conditions in Uganda

Details

• Alternative Title:
  BMC Public Health
• Personal Author:
  Amuron, Barbara ; Namara, Geoffrey ; Birungi, Josephine ; Nabiryo, Christine ; Levin, Jonathan ; Grosskurth, Heiner ; Coutinho, Alex ; Jaffar, Shabbar
• 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.
  
  
• Subjects:
  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
• Place as Subject:
  Uganda
• Volume:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:64627d054249e878d1ad6f04a15e98c91f60d10ea2a2f108f3db696b9d4a8751
• Download URL:
  https://stacks.cdc.gov/view/cdc/22967/cdc_22967_DS1.pdf
• File Type:
  [PDF - 408.96 KB ]