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

被引:47
作者
Cornell, Morna [1 ,2 ]
Johnson, Leigh F. [1 ]
Wood, Robin [3 ]
Tanser, Frank [4 ]
Fox, Matthew P. [5 ,6 ,7 ]
Prozesky, Hans [8 ,9 ]
Schomaker, Michael [1 ]
Egger, Matthias [1 ,10 ]
Davies, Mary-Ann [1 ]
Boulle, Andrew [1 ]
机构
[1] Univ Cape Town, Ctr Infect Dis Epidemiol & Res, Sch Publ Hlth & Family Med, Cape Town, South Africa
[2] Univ Cape Town, Div Epidemiol & Biostat, Sch Publ Hlth & Family Med, Cape Town, South Africa
[3] Univ Cape Town, Desmond Tutu HIV Ctr, Inst Infect Dis & Mol Med, Cape Town, South Africa
[4] Univ KwaZulu Natal, Africa Ctr Hlth & Populat Studies, Mtubatuba, South Africa
[5] Univ Witwatersrand, Hlth Econ & Epidemiol Res Off, Dept Internal Med, Sch Clin Med,Fac Hlth Sci, Johannesburg, South Africa
[6] Boston Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA USA
[7] Boston Univ, Sch Publ Hlth, Dept Global Hlth, Boston, MA USA
[8] Univ Stellenbosch, Dept Med, Div Infect Dis, Cape Town, South Africa
[9] Tygerberg Acad Hosp, Cape Town, South Africa
[10] Univ Bern, Div Int & Environm Hlth, ISPM, Bern, Switzerland
[11] Prov Govt Western Cape, Hlth Impact Assessment, Western Cape, South Africa
关键词
mortality; long-term; antiretroviral; viral suppression; gender; outcomes; Africa; TREATMENT PROGRAM; FOLLOW-UP; MULTIPLE IMPUTATION; SEX-DIFFERENCES; SCALE-UP; OUTCOMES; GENDER; CARE; SURVIVAL; HEALTH;
D O I
10.7448/IAS.20.1.21902
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
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 3.023.14)/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.
引用
收藏
页数:10
相关论文
共 59 条
  • [11] Adjusting Mortality for Loss to Follow-Up: Analysis of Five ART Programmes in Sub-Saharan Africa
    Brinkhof, Martin W. G.
    Spycher, Ben D.
    Yiannoutsos, Constantin
    Weigel, Ralf
    Wood, Robin
    Messou, Eugene
    Boulle, Andrew
    Egger, Matthias
    Sterne, Jonathan A. C.
    [J]. PLOS ONE, 2010, 5 (11):
  • [12] Grappling with uncertainties along the MDG trail
    Byass, Peter
    Graham, Wendy J.
    [J]. LANCET, 2011, 378 (9797) : 1119 - 1120
  • [13] The Imperfect World of Global Health Estimates
    Byass, Peter
    [J]. PLOS MEDICINE, 2010, 7 (11)
  • [14] Health in South Africa 1 The health and health system of South Africa: historical roots of current public health challenges
    Coovadia, Hoosen
    Jewkes, Rachel
    Barron, Peter
    Sanders, David
    McIntyre, Diane
    [J]. LANCET, 2009, 374 (9692) : 817 - 834
  • [15] Gender Differences in Survival among Adult Patients Starting Antiretroviral Therapy in South Africa: A Multicentre Cohort Study
    Cornell, Morna
    Schomaker, Michael
    Garone, Daniela Belen
    Giddy, Janet
    Hoffmann, Christopher J.
    Lessells, Richard
    Maskew, Mhairi
    Prozesky, Hans
    Wood, Robin
    Johnson, Leigh F.
    Egger, Matthias
    Boulle, Andrew
    Myer, Landon
    [J]. PLOS MEDICINE, 2012, 9 (09):
  • [16] Temporal changes in programme outcomes among adult patients initiating antiretroviral therapy across South Africa, 2002-2007
    Cornell, Morna
    Grimsrud, Anna
    Fairall, Lara
    Fox, Matthew P.
    van Cutsem, Gilles
    Giddy, Janet
    Wood, Robin
    Prozesky, Hans
    Mohapi, Lerato
    Graber, Claire
    Egger, Matthias
    Boulle, Andrew
    Myer, Landon
    [J]. AIDS, 2010, 24 (14) : 2263 - 2270
  • [17] Cornell M, 2009, SAMJ S AFR MED J, V99, P653
  • [18] Youth, unemployment, and male gender predict mortality in AIDS patients started on HAART in Nigeria
    Desilva, Malini B.
    Merry, Stephen P.
    Fischer, Philip R.
    Rohrer, James E.
    Isichei, Christian O.
    Cha, Stephen S.
    [J]. AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV, 2009, 21 (01): : 70 - 77
  • [19] Trends in ART Initiation among Men and Non-Pregnant/Non-Breastfeeding Women before and after Option B plus in Southern Malawi
    Dovel, Kathryn
    Yeatman, Sara
    van Oosterhout, Joep J.
    Chan, Adrienne
    Mantengeni, Alfred
    Landes, Megan
    Bedell, Richard
    Kawalazira, Gift
    Sodhi, Sumeet
    [J]. PLOS ONE, 2016, 11 (12):
  • [20] Men's heightened risk of AIDS-related death: the legacy of gendered HIV testing and treatment strategies
    Dovel, Kathryn
    Yeatman, Sara
    Watkins, Susan
    Poulin, Michelle
    [J]. AIDS, 2015, 29 (10) : 1123 - 1125