Abstract
BackgroundScale-up and expansion of antiretroviral therapy (ART) for people living with HIV (PLHIV) have been a global priority for more than 15 years.MethodsWe describe PLHIV at enrollment in care and ART initiation in Ethiopia, Kenya, Mozambique and Tanzania from 2005–2014 and report on enrollment location, CD4 count and loss to follow-up (LTF), death, and combined attrition (LTF and death) pre- and post-ART initiation over time. Pre-ART outcomes were estimated using competing risk and post-ART using Kaplan-Meier estimators; LTF defined as no visit within six months pre-ART and 12 months after ART start.ResultsFrom 2005–2014, 884,328 PLHIV enrolled in care at 350 health facilities, median age was 32.0 years (interquartile range [IQR] 26.0–42.0), and majority were female (66.5%). The proportion of PLHIV enrolled at primary and rural facilities increased from 12.9% and 15.3% in 2005–2006 to 43.5% and 41.7% in 2013–2014 (p<0.0001). Median CD4+ cell count at enrollment increased from 171 cell/mm3 in 2005–2006 (IQR 71–339) to 289 cell/mm3 in 2013–2014 (IQR 133–485) (p<0.0001). A total of 460,758 (57.4%) PLHIV initiated treatment. Cumulative risk of LTF for PLHIV prior to ART initiation 12 months after enrollment was 33.5% (95%CI 33.36–33.58) and 21.98% (95%CI 21.9–22.1) after ART initiation. Pregnant women and the youngest PLHIV group had the highest attrition after ART initiation, at 24 months 40.8% (95%CI 40.1–41.6) of pregnant women and 47.4% (95%CI 46.4–48.4) of PLHIV 15–19 years were not retained. Attrition at 12 months after enrollment among PLHIV regardless of ART status was 38.5% (95%CI 38.4–38.6).ConclusionOver 10 years of HIV scale-up in four sub-Saharan African countries, close to a million PLHIV were enrolled in care increasingly at rural and primary facilities with increasing CD4 count. Loss to follow-up from HIV care remains alarmingly high, particularly among pregnant women and younger PLHIV.
Highlights
Scale-up and expansion of antiretroviral therapy (ART) for people living with HIV (PLHIV) have been a global priority for more than 15 years.Editor: Kwasi Torpey, University of Ghana College of Health Sciences, GHANAReceived: February 10, 2020Accepted: March 27, 2020Published: April 16, 2020
We examined a large patient level dataset from 350 HIV care and treatment facilities in Ethiopia, Kenya, Mozambique, and Tanzania from 2005 through 2014 to describe the characteristics of PLHIV at entry to HIV care and at ART initiation over time
We describe characteristics of PLHIV at enrollment in HIV care and at time of ART initiation based on year of enrollment and country including age, sex, point of entry, CD4 cell count (CD4+), and World Health Organization (WHO) HIV disease stage
Summary
Scale-up and expansion of antiretroviral therapy (ART) for people living with HIV (PLHIV) have been a global priority for more than 15 years. Data Availability Statement: The data are owned by the governments of each country (Ethiopia, Kenya, Mozambique and Tanzania) who have not agreed to make the data publicly available. The CDC office in each country has copies of the data sets and requests can be made those those offices. For access to the data, please contact ICAP at Columbia University which will facilitate data access (email: ct116@columbia.edu or az2258@columbia.edu)
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