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• Alternative Title:
  PLoS One
• Personal Author:
  Auld, Andrew F. ; Mbofana, Francisco ; Shiraishi, Ray W. ; Sanchez, Mauro ; Alfredo, Charity ; Nelson, Lisa J. ; Ellerbrock, Tedd
• Description:
  Background
  
  In Mozambique during 2004–2007 numbers of adult patients (≥15 years old) enrolled on antiretroviral therapy (ART) increased about 16-fold, from <5,000 to 79,500. All ART patients were eligible for co-trimoxazole. ART program outcomes, and determinants of outcomes, have not yet been reported.
  
  Methodology/Principal Findings
  
  In a retrospective cohort study, we investigated rates of mortality, attrition (death, loss to follow-up, or treatment cessation), immunologic treatment failure, and regimen-switch, as well as determinants of selected outcomes, among a nationally representative sample of 2,596 adults initiating ART during 2004–2007. At ART initiation, median age of patients was 34 and 62% were female. Malnutrition and advanced disease were common; 18% of patients weighed <45 kilograms, and 15% were WHO stage IV. Median baseline CD4+ T-cell count was 153/µL and was lower for males than females (139/µL vs. 159/µL, p<0.01). Stavudine, lamivudine, and nevirapine or efavirenz were prescribed to 88% of patients; only 31% were prescribed co-trimoxazole. Mortality and attrition rates were 3.4 deaths and 19.8 attritions per 100 patient-years overall, and 12.9 deaths and 57.2 attritions per 100 patient-years in the first 90 days. Predictors of attrition included male sex [adjusted hazard ratio (AHR) 1.5; 95% confidence interval (CI), 1.3–1.8], weight <45 kg (AHR 2.1; 95% CI, 1.6–2.9, reference group >60 kg), WHO stage IV (AHR 1.7; 95% CI, 1.3–2.4, reference group WHO stage I/II), lack of co-trimoxazole prescription (AHR 1.4; 95% CI, 1.0–1.8), and later calendar year of ART initiation (AHR 1.5; 95% CI, 1.2–1.8). Rates of immunologic treatment failure and regimen-switch were 14.0 and 0.6 events per 100-patient years, respectively.
  
  Conclusions
  
  ART initiation at earlier disease stages and scale-up of co-trimoxazole among ART patients could improve outcomes. Research to determine reasons for low regimen-switch rates and increasing rates of attrition during program expansion is needed.
  
  
• Subjects:
  Adult Anti-HIV Agents CD4 Lymphocyte Count Cohort Studies Female HIV Infections Humans Lost To Follow-Up Male Middle Aged Patient Compliance Retrospective Studies Time Factors Treatment Failure Weight Gain

  More +
• Source:
  PLoS One. 6(4).
• Pubmed ID:
  21483703
• Pubmed Central ID:
  PMC3070740
• Document Type:
  Journal Article
• Place as Subject:
  Mozambique
• Volume:
  6
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:c4f9df5b4f0c798b9d21551a2c6066ca3b1f4c45113875ebce5713a62395e95a
• Download URL:
  https://stacks.cdc.gov/view/cdc/4318/cdc_4318_DS1.pdf
• File Type:
  [PDF - 465.92 KB ]