Abstract
BackgroundIn 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 FindingsIn 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.ConclusionsART 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.
Highlights
During 2004–2009, the number of HIV-infected patients enrolled on antiretroviral therapy (ART) increased more than 10-fold, from less than 400,000 to more than five million, with most new ART patients enrolled in sub-Saharan Africa [1]
Reporting treatment outcomes of patients enrolled in ART programs is important to demonstrate program effectiveness and justify continued funding, while assessment of factors associated with outcomes can help to identify opportunities for program improvement [2,3]
At ART initiation, median age of patients was 34 years, and 62% were female of whom 16% were pregnant
Summary
During 2004–2009, the number of HIV-infected patients enrolled on antiretroviral therapy (ART) increased more than 10-fold, from less than 400,000 to more than five million, with most new ART patients enrolled in sub-Saharan Africa [1]. Many sub-national ART programs in subSaharan Africa have reported their treatment experience [4,5,6,7,8,9,10,11,12], only a few studies can be considered nationally representative due to the large cohort size [6,12], or sampling design [13]. In Mozambique, where about 1.6 million people are HIVinfected and about 473,000 need ART [14], numbers of adult patients ($15 years old) enrolled on ART increased about 16fold from less than 5,000 to 79,500 during 2004–2007 [15]. 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. ART program outcomes, and determinants of outcomes, have not yet been reported
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
