Effectiveness of a multivitamin supplementation program among HIV-infected adults in Tanzania

Details

• Alternative Title:
  AIDS
• Personal Author:
  SUDFELD, Christopher R. ; BUCHANAN, Ashley ; ULENGA, Nzovu ; SPIEGELMAN, Donna ; MTISI, Expeditho ; HERTZMARK, Ellen ; MUYA, Aisa N. ; SANDO, David ; MUNGURE, Ester ; MIZINDUKO, Mucho ; FAWZI, Wafaie W.
• Description:
  Objective:
  
  The objective of this study was to assess the effectiveness of a routine multivitamin supplementation program for adults living with HIV in Tanzania.
  
  Design:
  
  We conducted a retrospective cohort study of 67,707 adults enrolled in the Dar es Salaam HIV care and treatment program during 2004–2012.
  
  Methods:
  
  The Dar es Salaam HIV care and treatment program intended to provide all adult patients with multivitamin supplements (vitamins B-complex, C, and E) free of charge; however, intermittent stockouts and other implementation issues did not afford universal coverage. We use Cox proportional hazard models to assess the time-varying association of multivitamin supplementation with mortality and clinical outcomes.
  
  Results:
  
  The study cohort contributed 41,540 and 129,315 person-years of follow-up time to the ART-naïve and ART-experienced analyses, respectively. Among 48,207 ART-naïve adults, provision of multivitamins reduced the risk of mortality (adjusted hazard ratio (aHR): 0.69; 95% CI: 0.59–0.81), incident tuberculosis (TB) (aHR: 0.83; 0.76–0.91), and meeting ART eligibility criteria (aHR: 0.78; 95% CI: 0.73–0.83) after adjustment for time-varying confounding. Among 46,977 ART-experienced patients, multivitamins reduced mortality (HR: 0.86; 95% CI: 0.80–0.92), incident TB (aHR: 0.78; 95% CI: 0.73–0.84), and immunologic failure (aHR: 0.70; 95% CI: 0.67–0.73). The survival benefits associated with provision multivitamins appeared to be greatest during the first year of ART and declined over time (p-value <0.001).
  
  Conclusion:
  
  Multivitamin supplementation appears to be a simple, effective, safe, and scalable program to improve survival, reduce incidence of TB, and improve treatment outcomes for adult HIV patients in Tanzania.
  
  
• Subjects:
  Article Cohort Study HIV Implementation Science Micronutrient Nutrition Supplement Tuberculosis
• Source:
  AIDS. 33(1):93-100
• Pubmed ID:
  30289815
• Pubmed Central ID:
  PMC6599688
• Document Type:
  Journal Article
• Funding:
  D43 TW009775/TW/FIC NIH HHS/United States ; U2G PS001966/PS/NCHHSTP CDC HHS/United States ; PEPFAR/PEPFAR/United States
• Place as Subject:
  Tanzania
• Volume:
  33
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:0cd2202e785d337935a43bfb47d7aac79f2a3ec8cbb9ec63d34f532ac6f1060c
• Download URL:
  https://stacks.cdc.gov/view/cdc/79579/cdc_79579_DS1.pdf
• File Type:
  [PDF - 331.60 KB ]