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. 2016 Jan 28;30(3):477-85.
doi: 10.1097/QAD.0000000000000921.

Trends and determinants of survival for over 200 000 patients on antiretroviral treatment in the Botswana National Program: 2002-2013

Mansour Farahani  1 , Natalie Price, Shenaaz El-Halabi, Naledi Mlaudzi, Koona Keapoletswe, Refeletswe Lebelonyane, Ernest Benny Fetogang, Tony Chebani, Poloko Kebaabetswe, Tiny Masupe, Keba Gabaake, Andrew Auld, Oathokwa Nkomazana, Richard Marlink
Affiliations

Trends and determinants of survival for over 200 000 patients on antiretroviral treatment in the Botswana National Program: 2002-2013

Mansour Farahani et al. AIDS. .

Abstract

Objectives: To determine the incidence and risk factors of mortality for all HIV-infected patients receiving antiretroviral treatment at public and private healthcare facilities in the Botswana National HIV/AIDS Treatment Programme.

Design: We studied routinely collected data from 226 030 patients enrolled in the Botswana National HIV/AIDS Treatment Programme from 2002 to 2013.

Methods: A person-years (P-Y) approach was used to analyse all-cause mortality and follow-up rates for all HIV-infected individuals with documented antiretroviral therapy initiation dates. Marginal structural modelling was utilized to determine the effect of treatment on survival for those with documented drug regimens. Sensitivity analyses were performed to assess the robustness of our results.

Results: Median follow-up time was 37 months (interquartile range 11-75). Mortality was highest during the first 3 months after treatment initiation at 11.79 (95% confidence interval 11.49-12.11) deaths per 100 P-Y, but dropped to 1.01 (95% confidence interval 0.98-1.04) deaths per 100 P-Y after the first year of treatment. Twelve-month mortality declined from 7 to 2% of initiates during 2002-2012. Tenofovir was associated with lower mortality than stavudine and zidovudine.

Conclusion: The observed mortality rates have been declining over time; however, mortality in the first year, particularly first 3 months of antiretroviral treatment, remains a distinct problem. This analysis showed lower mortality with regimens containing tenofovir compared with zidovudine and stavudine. CD4 cell count less than 100 cells/μl, older age and being male were associated with higher odds of mortality.

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Figures

Fig. 1
Fig. 1
Description of Botswana National Antiretroviral Treatment Programme data.
Fig. 2
Fig. 2
Distribution of yearly deaths by duration of treatment.
Fig. 3
Fig. 3
Mortality rate in the first year after treatment initiation.
See this image and copyright information in PMC

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References

    1. UNAIDS. Report on the global HIV/AIDS epidemic. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS, 2000.
    1. M&E Division. Ministry of Health Quarterly HAART Report Q1. Gaborone: Botswana; 2015.
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    1. WHO. Case Study: Country-enhanced monitoring and evaluation for antiretroviral therapy scale-up: analysis and use of strategic information in Botswana. In: HIV/AIDS Programme Strengthening Health Services to Fight HIV/AIDS. Geneva, Switzerland: World Health Organization; 2006.
    1. Farahani M, Vable A, Lebelonyane R, Seipone K, Anderson M, Avalos A, et al. Outcomes of the Botswana National HIV/AIDS Treatment Programme from 2002 to 2010: a longitudinal analysis. Lancet Glob Health 2014; 2:e44–e50. - PubMed

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