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Mortality and loss to follow-up in the first year of ART

Weigel, Ralf ORCID:, Estill, Janne, Egger, Matthias, Harries, Anthony D., Makombe, Simon, Tweya, Hannock, Jahn, Andreas and Keiser, Olivia (2012) 'Mortality and loss to follow-up in the first year of ART'. AIDS, Vol 26, Issue 3, pp. 365-373.

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Objectives: To analyse mortality, loss to follow-up (LTFU) and retention on antiretroviral treatment (ART) in the first year of ART across all age groups in the Malawi national ART programme.
Design: Cohort study including all patients who started ART in Malawi's public sector clinics between 2004 and 2007.
Methods: ART registers were photographed, information entered into a database and merged with data from clinics with electronic records. Rates per 100 patient-years and cumulative incidence of retention were calculated. Subhazard ratios (sHRs) of outcomes adjusted for patient and clinic-level characteristics were calculated in multivariable analysis, applying competing risk models.
Results: A total of 117 945 patients contributed 85 246 person-years: 1.0% were infants below 2 years, 7.4% children 2–14, 7.5% young people 15–24, and 84.2% adults 25 years and above. Sixty percent of patients were female: women outnumbered men from age 14 to 35 years. Mortality and LTFU were higher in men from age 20 years. Infants and young people had the highest rates per 100 person-years for mortality (23.0 and 19.4) and LTFU (24.7 and 19.3), and the highest adjusted relative risks compared to age group 25–34 years: sHRs were 1.37 [95% confidence interval (CI) 1.17–1.60] and 1.17 (95% CI 1.10–1.25) for death and 1.37 (95% CI 1.18–1.59) and 1.27 (95% CI 1.19–1.35) for LTFU, respectively.
Conclusion: In this country-wide study patients aged 0–1 and 15–24 years had the highest risk of death and LTFU, and from age 20 men were at higher risk than women. Interventions to improve outcomes in these patient groups are required.

Item Type: Article
Uncontrolled Keywords: antiretroviral therapy, loss to follow-up, Malawi, mortality, retention on ART
Subjects: W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 85 Patients. Attitude and compliance
W General Medicine. Health Professions > W 26.5 Informatics. Health informatics
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WB Practice of Medicine > Therapeutics > WB 340 Drug Administration
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.2 Therapy
Faculty: Department: Groups (2002 - 2012) > International Health Group
Digital Object Identifer (DOI):
Depositing User: Martin Chapman
Date Deposited: 09 Dec 2014 12:14
Last Modified: 06 Feb 2018 13:08


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