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Retention and mortality on antiretroviral therapy in sub-Saharan Africa: collaborative analyses of HIV treatment programmes

dc.rights.licenseopenen_US
dc.contributor.authorHAAS, A. D.
dc.contributor.authorZANIEWSKI, E.
dc.contributor.authorANDEREGG, N.
dc.contributor.authorFORD, N.
dc.contributor.authorFOX, M. P.
dc.contributor.authorVINIKOOR, M.
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorDABIS, Francois
dc.contributor.authorNASH, D.
dc.contributor.authorSINAYOBYE, J. D.
dc.contributor.authorNIYONGABO, T.
dc.contributor.authorTANON, A.
dc.contributor.authorPODA, A.
dc.contributor.authorADEDIMEJI, A. A.
dc.contributor.authorEDMONDS, A.
dc.contributor.authorDAVIES, M. A.
dc.contributor.authorEGGER, M.
dc.date.accessioned2020-11-16T09:23:46Z
dc.date.available2020-11-16T09:23:46Z
dc.date.issued2018-02
dc.identifier.issn1758-2652 (Electronic) 1758-2652 (Linking)en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/14011
dc.description.abstractEnINTRODUCTION: By 2020, 90% of all people diagnosed with HIV should receive long-term combination antiretroviral therapy (ART). In sub-Saharan Africa, this target is threatened by loss to follow-up in ART programmes. The proportion of people retained on ART long-term cannot be easily determined, because individuals classified as lost to follow-up, may have self-transferred to another HIV treatment programme, or may have died. We describe retention on ART in sub-Saharan Africa, first based on observed data as recorded in the clinic databases, and second adjusted for undocumented deaths and self-transfers. METHODS: We analysed data from HIV-infected adults and children initiating ART between 2009 and 2014 at a sub-Saharan African HIV treatment programme participating in the International epidemiology Databases to Evaluate AIDS (IeDEA). We used the Kaplan-Meier method to calculate the cumulative incidence of retention on ART and the Aalen-Johansen method to calculate the cumulative incidences of death, loss to follow-up, and stopping ART. We used inverse probability weighting to adjust clinic data for undocumented mortality and self-transfer, based on estimates from a recent systematic review and meta-analysis. RESULTS: We included 505,634 patients: 12,848 (2.5%) from Central Africa, 109,233 (21.6%) from East Africa, 347,343 (68.7%) from Southern Africa and 36,210 (7.2%) from West Africa. In crude analyses of observed clinic data, 52.1% of patients were retained on ART, 41.8% were lost to follow-up and 6.0% had died 5 years after ART initiation. After accounting for undocumented deaths and self-transfers, we estimated that 66.6% of patients were retained on ART, 18.8% had stopped ART and 14.7% had died at 5 years. CONCLUSIONS: Improving long-term retention on ART will be crucial to attaining the 90% on ART target. Naive analyses of HIV cohort studies, which do not account for undocumented mortality and self-transfer of patients, may severely underestimate both mortality and retention on ART.
dc.language.isoENen_US
dc.rightsAttribution 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/us/*
dc.subject.enIDLIC
dc.subject.enleDEA
dc.title.enRetention and mortality on antiretroviral therapy in sub-Saharan Africa: collaborative analyses of HIV treatment programmes
dc.title.alternativeJ Int AIDS Socen_US
dc.typeArticle de revueen_US
dc.identifier.doi10.1002/jia2.25084en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed29479867en_US
bordeaux.journalJournal of the International AIDS Societyen_US
bordeaux.volume21en_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.issue2en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.teamIDLICen_US
bordeaux.teamleDEAen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.identifierhal-03006877
hal.version1
hal.date.transferred2020-11-16T09:23:51Z
hal.exporttrue
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