TITLE

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

AUTHOR(S)
Amuron, Barbara; Namara, Geoffrey; Birungi, Josephine; Nabiryo, Christine; Levin, Jonathan; Grosskurth, Heiner; Coutinho, Alex; Jaffar, Shabbar
PUB. DATE
January 2009
SOURCE
BMC Public Health;2009, Vol. 9 Issue 1, p290
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
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 pretreatment 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.
ACCESSION #
44171703

 

Related Articles

  • Screening HIV-infected adults in Malawi for anaemia: impact on eligibility for antiretroviral therapy. Page, I D; McKew, S J; Kudzala, A G; Fullwood, C; van Oosterhout, J J; Bates, I // International Journal of STD & AIDS;Jun2013, Vol. 24 Issue 6, p449 

    Clinical staging determines antiretroviral therapy (ART) eligibility when CD4 count is not available. Haemoglobin (Hb) ≤8 g/dL is an indication for the treatment. We measured Hb in HIV-positive Malawian adults undergoing clinical assessment for ART eligibility and calculated the percentage...

  • Dried blood spots can expand access to virological monitoring of HIV treatment in resource-limited settings. Johannessen, Asgeir; Trøseid, Marius; Calmy, Alexandra // Journal of Antimicrobial Chemotherapy (JAC);Dec2009, Vol. 64 Issue 6, p1126 

    The global scale-up of antiretroviral treatment in past years has, unfortunately, not been accompanied by adequate strengthening of laboratory capacity. Monitoring of treatment with HIV viral load and resistance testing, as recommended in industrialized countries, is rarely available in...

  • Human Bocavirus 1 Primary Infection and Shedding in Infants. Linas, Benjamin P. // Journal of Infectious Diseases;8/15/2015, Vol. 212 Issue 4, p516 

    Background. Human bocavirus 1 (HBoV-1) is frequently detected in young children. The role of HBoV-1 in respiratory illness is unclear, owing to frequent detection in asymptomatic children. Methods. Weekly oral fluid samples from a longitudinal cohort of infants were tested by quantitative...

  • Shifting our focus to HIV as a chronic disease. Hickner, John // Journal of Family Practice;Jul2014, Vol. 63 Issue 7, p355 

    The author reflects on the evolution of diagnosis and treatment of HIV infections. Topics discussed by the author include discovery of highly active antiretroviral therapy (HAART) which has transformed HIV and AIDS to a chronic primary care disease from an acute and infectious disease, the...

  • Partners of people on ART - a New Evaluation of the Risks (The PARTNER study): design and methods.  // BMC Public Health;2012, Vol. 12 Issue 1, p296 

    The article presents the findings of a research conducted on examining the risk of HIV transmission in a person on ART. It mentions that this PARTNER study is an international and observational study taking place from 2010 to 2014, in which HIV serodifferent partnerships who at enrolment...

  • Cost-effectiveness estimates for antenatal HIV testing in the Netherlands. Rozenbaum, M. H.; Verweel, G.; Folkerts, D. K. F.; Dronkers, F.; Van den Hoek, J. A. R.; Hartwig, N. G.; de Groot, R.; Postma, M. J. // International Journal of STD & AIDS;Oct2008, Vol. 19 Issue 10, p668 

    This paper provides an estimation of the lifetime health-care cost of HIV-infected children and an update of the costeffectiveness of universal HIV-screening of pregnant women in Amsterdam (The Netherlands). During 2003-2005, we collected data concerning the prevalence of newly diagnosed...

  • Contraceptive Use and Method Preference among Women in Soweto, South Africa: The Influence of Expanding Access to HIV Care and Treatment Services. Kaida, Angela; Laher, Fatima; Strathdee, Steffanie A.; Money, Deborah; Janssen, Patricia A.; Hogg, Robert S.; Gray, Glenda // PLoS ONE;2010, Vol. 5 Issue 11, p1 

    Objective: Preventing unintended pregnancy among HIV-positive women constitutes a critical and cost-effective approach to primary prevention of mother-to-child transmission of HIV and is a global public health priority for addressing the desperate state of maternal and child health in HIV...

  • HAART may be effective for HIV epidemic control.  // PharmacoEconomics & Outcomes News;7/24/2010, Issue 608, p4 

    The article discusses research study on the association of highly active antiretroviral therapy, coverage, population viral load and yearly new human immunodeficiency virus (HIV) diagnoses in British Columbia, referencing a study by J. S. G. Montaner and colleagues published in the July 18, 2010...

  • Abacavir/efavirenz/nelfinavir.  // Reactions Weekly;2/13/2010, Issue 1288, p5 

    The article describes the case of a 51-year-old man who developed partial anterior interosseous nerve palsy during highly active antiretroviral therapy (HAART) with abacavir, efavirenz and nelfinavir for a HIV infection.

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics