Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Apr 4;6(4):e18453.
doi: 10.1371/journal.pone.0018453.

Four-year treatment outcomes of adult patients enrolled in Mozambique's rapidly expanding antiretroviral therapy program

Andrew F Auld  1 , Francisco Mbofana, Ray W Shiraishi, Mauro Sanchez, Charity Alfredo, Lisa J Nelson, Tedd Ellerbrock
Affiliations

Four-year treatment outcomes of adult patients enrolled in Mozambique's rapidly expanding antiretroviral therapy program

Andrew F Auld et al. PLoS One. .

Abstract

Background: 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. All ART patients were eligible for co-trimoxazole. ART program outcomes, and determinants of outcomes, have not yet been reported.

Methodology/principal findings: In 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.

Conclusions: ART 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.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Kaplan-Meier Analysis (imputed dataset 1).
Figure 2
Figure 2. Modeled changes in CD4 count for surviving patients initiating antiretroviral therapy during 2004–2007.
Figure 3
Figure 3. Modeled changes in weight over time for surviving patients initiating ART during 2004–2007.
See this image and copyright information in PMC

References

    1. World Health Organization. Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector - Progress report. 2010. Geneva, Switzerland: WHO; 2010. Avaliable: http://www.who.int/hiv/pub/2010progressreport/en/. Accessed 29 January 2011.
    1. Boerma JT, Stanecki KA, Newell ML, Luo C, Beusenberg M, et al. Monitoring the scale-up of antiretroviral therapy programmes: methods to estimate coverage. Bull World Health Organ. 2006;84:145–150. - PMC - PubMed
    1. Bennett S, Boerma JT, Brugha R. Scaling up HIV/AIDS evaluation. Lancet. 2006;367:79–82. - PubMed
    1. Laurent C, Ngom Gueye NF, Ndour CT, Gueye PM, Diouf M, et al. Long-term benefits of highly active antiretroviral therapy in Senegalese HIV-1-infected adults. J Acquir Immune Defic Syndr. 2005;38:14–17. - PubMed
    1. Ferradini L, Jeannin A, Pinoges L, Izopet J, Odhiambo D, et al. Scaling up of highly active antiretroviral therapy in a rural district of Malawi: an effectiveness assessment. Lancet. 2006;367:1335–1342. - PubMed

Publication types

Substances