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. 2009 Jul;14(7):722-31.
doi: 10.1111/j.1365-3156.2009.02290.x. Epub 2009 Apr 27.

The impact of gender and income on survival and retention in a South African antiretroviral therapy programme

Morna Cornell  1 , Landon Myer, Richard Kaplan, Linda-Gail Bekker, Robin Wood
Affiliations

The impact of gender and income on survival and retention in a South African antiretroviral therapy programme

Morna Cornell et al. Trop Med Int Health. 2009 Jul.

Abstract

Objectives: Despite the rapid expansion of antiretroviral therapy (ART) services in Africa, there are few data on whether outcomes differ for women and men and what factors may drive such variation. We investigated the association of gender and income with survival and retention in a South African ART programme.

Methods: A total of 2196 treatment-naïve adults were followed for 1 year on ART. Proportional hazards regression was used to explore associations between baseline characteristics and survival and loss-to-follow-up (LTFU).

Results: Patients were predominantly female (67%). Men presented at an older age and with more advanced HIV disease, and during early ART the crude death rate was higher among men than women (22.8 vs 12.5/100 person-years; P = 0.002). However in multivariate analysis, gender was not significantly associated with survival after adjusting for baseline clinical and immunovirological status (HR = 1.46, 95% CI = 0.96-2.22; P = 0.076). In late ART (4-12 months), there was no gender difference in mortality rates (3.5 vs 3.8/100 person-years; P = 0.817). In multivariate analysis, survival was strongly associated with age (HR = 1.05, 95% CI = 1.02-1.09; P < 0.001), CD4 count >150 vs <50 cells/microl (HR = 0.35, 95% CI = 0.14-0.87; P = 0.023) and any monthly income vs none (HR = 0.47, 95% CI = 0.25-0.88; P = 0.018). Having some monthly income was protective against LTFU at 1 year on ART (adjusted HR = 0.56, 95% CI = 0.39-0.82; P = 0.002).

Conclusion: Men's high early mortality on ART appears due largely to their presentation with more advanced HIV disease. Efforts are needed to enroll men into care earlier in HIV disease and to reduce socio-economic inequalities in ART programme outcomes.

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Conflict of interest statement

Conflicts of interest

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Description of an adult ART programme cohort, Gugulethu, South Africa: September 2002 – April 2007
Figure 2
Figure 2
Kaplan-Meier survival estimates of survival by patient gender: 0–4 months and 4–12 months on antiretroviral therapy
Figure 3
Figure 3
Kaplan-Meier estimates: the impact of gender and income on (a) survival and (b) loss-to-follow-up during the first 12 months on antiretroviral therapy
See this image and copyright information in PMC

References

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