Accounting for and responding to HIV-associated mortality

Ford, Nathan; Boulle, Andrew; Egger, Matthias

doi:10.1097/qad.0000000000000900

Cited by 8 publications

(10 citation statements)

References 21 publications

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“…Numerous studies over the past ten years have addressed the complex issue of mortality estimation, particularly in developing countries [41][42][43][44][45][46]. Many countries with large, rapidly expanding ART programmes lack functioning vital registration systems, and mortality ascertainment from standard patients' record systems may misclassify a high proportion of deaths as LTF [12,41]. To correct for mortality among patients LTF, different approaches have been used including tracing studies [47][48][49] and the application of a nomogram [44].…”

Section: Discussionmentioning

confidence: 99%

“…Using routine data captured by sites, we have previously reported decreasing mortality in the first year of ART in successive calendar years of ART initiation [11]. Such apparent declines in mortality may be real or could be due to deteriorating mortality ascertainment and retention in rapidly expanding ART programmes [12,13]. Indeed, as access to ART has expanded, routine data have increasingly underestimated true mortality: the proportion of deaths recorded in South African ART programmes dropped from 60% to 30% (2004-2005 compared with 2010 onwards) [13].…”

Section: Introductionmentioning

confidence: 99%

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Twelve‐year mortality in adults initiating antiretroviral therapy in South Africa

Cornell

Johnson

Wood

et al. 2017

Journal of the International AIDS Society

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Introduction: South Africa has the largest number of individuals living with HIV and the largest antiretroviral therapy (ART) programme worldwide. In September 2016, ART eligibility was extended to all 7.1 million HIV-positive South Africans. To ensure that further expansion of services does not compromise quality of care, long-term outcomes must be monitored. Few studies have reported long-term mortality in resource-constrained settings, where mortality ascertainment is challenging. Combining site records with data linked to the national vital registration system, sites in the International Epidemiology Databases to Evaluate AIDS Southern Africa collaboration can identify >95% of deaths in patients with civil identification numbers (IDs). This study used linked data to explore long-term mortality and viral suppression among adults starting ART in South Africa. Methods: The study was a cohort analysis of routine data on adults with IDs starting ART 2004–2015 in five large ART cohorts. Mortality was estimated overall and by gender using the Kaplan-Meier estimator and Cox’s proportional hazards regression. Standardized mortality ratios (SMRs) were calculated by dividing observed numbers of deaths by numbers expected if patients had been HIV-negative. Viral suppression in patients with viral loads (VLs) in their last year of follow-up was the secondary outcome. Results: Among 72,812 adults followed for 350,376 person years (pyrs), the crude mortality rate was 3.08 (95% CI 3.02–3.14)/100 pyrs. Patients were predominantly female (67%) and the percentage of men initiating ART did not increase. Cumulative mortality 12 years after ART initiation was 23.9% (33.4% male and 19.4% female). Mortality peaked in patients enrolling in 2007–2009 and was higher in men than women at all durations. Observed mortality rates were higher than HIV-negative mortality, decreasing with duration. By 48 months, observed mortality was close to that in the HIV-negative population, and SMRs were similar for all baseline CD4 strata. Three-quarters of patients had VLs in their last year, and 86% of these were virally suppressed. Conclusions: The South African ART programme has shown a remarkable ability to initiate and manage patients successfully over 12 years, despite rapid expansion. With further scale-up, testing and initiating men on ART must be a national priority.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Twelve‐year mortality in adults initiating antiretroviral therapy in South Africa

Cornell

Johnson

Wood

et al. 2017

Journal of the International AIDS Society

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“…In Ethiopia, by 2015, a total of 399,380 adults were on Antiretroviral Therapy (ART) (Wang & his colleagues., 2016); and among those started on Antiretroviral Drugs (ARVs), almost 70% remained on treatment (Samuel., Jani & Kassa., 2016). The introduction of ART in 1996 (Ford., Boulle & Egger., 2016) and the scale up programs (WHO., 2011) has significantly transformed HIV/AIDS, from once unmanageable disease to a manageable one (Heyer & Ogunbanjo., 2006). Though ART has changed the clinical development of HIV infection and making it a chronic manageable disease; yet, optimal and strict ART adherence -over 95% adherence to ART needed for over the long period (Ammassari., PaolaTrotta & Mul., 2005;FMOH., 2006).…”

Section: Introductionmentioning

confidence: 99%

Antiretroviral Therapy Adherence Level and Associated Factors Among HIV/AIDS Patients in Jimma Zone Government Health Facilities, ART Clinics, South-west Ethiopia

Hassen

Mohammed

2019

IJMMU

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Optimal and strict adherence to Antiretroviral Viral Therapy a need for over the long period to achieve the goals of ART and obtain maximum benefits of ART. However, PLWHA find it very difficult to take ARVs drug as precisely as they should for a number of reasons. Therefore, this study aimed at examining the level of antiretroviral therapy adherence and identifying possible associated factors for ART adherence behavior in Jimma zone government ART facilities. A facility based cross-sectional study was conducted in the ART clinics of Jimma zone governmental health facilities in which ARV treatment supplied from November 25/2015 – February 30/2016 for a period of 4 months. 352 adult PLWHA (190 female and 162 male) ranged in age from 15-62 years (Mean=37.1, SD= 8.95), with 100% response rate, were our study participants. Binary logistic regression was used to perform bivariate and multivariate analyses to determine the association between study variables and ART adherence status. 259(73.6%) participants were adherent (>=95%) and 93(26.4%) were non-adherent (<95%) to the prescribed dose of ARV drugs over the past seven days prior to the interview. The main reasons for skipping the prescribed ARV drugs were, busyness (78.5%), having too many pills (71%), felt depressed (68.8%), taking the drugs reminded HIV infected (66.7%), did not want other see (62.4%), and felt asleep(60.2%). The last stepwise regression analysis revealed that, educational status, knowledge of HIV/AIDS, use of additional drugs and access to reliable pharmacy were significantly associated with ART adherence status. So, efforts to maximize ART adherence should focus on addressing these associated significant factors.

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“…Sub-Saharan Africa (SSA) contributed 76% (29 million) of the total HIV-infected people, 76% (1.9 million) of the total new HIV infections, and 75% (0.9 million) of the total HIV/AIDS deaths[1]. The advent of antiretroviral therapy (ART) in 1996 significantly reduced HIV-related deaths[2]. The global ART coverage in 2015 was low[3] (40.6%), with North Africa and Middle East having the lowest coverage (19%).…”

Section: Introductionmentioning

confidence: 99%

Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015

et al. 2017

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BackgroundIt is well acknowledged that antiretroviral therapy (ART) discontinuation hampers the progress towards achieving the UNAIDS treatment targets that aim to treat 90% of HIV diagnosed patients and achieve viral suppression for 90% of those on treatment. Nevertheless, the magnitude, trend and risk factors for ART discontinuation have not been explored extensively. We carried out a retrospective data analysis to assess prevalence, trend and risk factors for ART discontinuation among adults in Southwest Ethiopia.Methods12 years retrospective cohort analysis was performed with 4900 HIV-infected adult patients between 21 June 2003 and 15 March 2015 registered at the ART clinic at Jimma University Teaching Hospital. ART discontinuation could be loss to follow-up, defaulting and/or stopping medication while remaining in care. Because data for 2003 and 2015 were incomplete, the 10 years data were used to describe trends for ART discontinuation using a line graph. We used binary logistic regression to identify factors that were correlated with ART discontinuation. To handle missing data, we applied multiple imputations assuming missing at random pattern.ResultsIn total, 4900 adult patients enrolled on ART, of whom 1090 (22.3%) had discontinued, 954 (19.5%) had transferred out, 300 (6.1%) had died, 2517 (51.4%) were alive and on ART, and the remaining 39 (0.8%) had unknown outcome status. The trend of ART discontinuation showed an upward direction in the recent times and reached a peak, accounting for a magnitude of 10%, in 2004 and 2005. Being a female (AOR = 2.1, 95%CI: 1.7–2.8), having an immunological failure (AOR = 2.3, 1.9–8.2), having tuberculosis/HIV co-infection (AOR = 1.5, 1.1–2.1) and no previous history of HIV testing (AOR = 1.8, 1.4–2.9) were the risk factors for ART discontinuation.ConclusionsOne out of five adults had discontinued from ART, and the trend of ART discontinuation increased recently. Discontinued adults were more likely to be females, tuberculosis/HIV co-infected, with immunological failure and no history of HIV testing. Therefore, it is vital to implement effective programs such as community ART distribution and linkage-case-management to enhance ART linkage and retention.

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Accounting for and responding to HIV-associated mortality

Cited by 8 publications

References 21 publications

Twelve‐year mortality in adults initiating antiretroviral therapy in South Africa

Twelve‐year mortality in adults initiating antiretroviral therapy in South Africa

Antiretroviral Therapy Adherence Level and Associated Factors Among HIV/AIDS Patients in Jimma Zone Government Health Facilities, ART Clinics, South-west Ethiopia

Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015

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