Please use this identifier to cite or link to this item: http://hdl.handle.net/10311/1642
Title: Trends and determinants of survival for over 200 000 patients on antiretroviral treatment in the Botswana National Program: 2002–2013
Authors: Kebaabetswe, Poloko
Farahani, Mansour
Price, Natalie
El-Halabi, Shenaaz
Mlaudzi, Naledi
Keapoletswe, Koona
Lebelonyane, Refeletswe
Fetogang, Ernest Benny
Chebani, Tony
Masupe, Tiny
Gabaake, Keba
Auld, Andrew
Nkomazana, Oathokwa
Marlinka, Richard
Keywords: Art
HIV
marginal structural model
mortality
Botswana
Issue Date: 28-Jan-2016
Publisher: Lippincott,Williams & Wilkin; https://www.ajj.com/clients/list/lww
Citation: Farahani, M. et al (2016) Trends and determinants of survival for over 200 000 patients on antiretroviral treatment in the Botswana National Program: 2002–2013, AIDS, Vol. 30, No. 3, pp. 477-485
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. CD4þ cell count less than 100 cells/ml, older age and being male were associated with higher odds of mortality.
URI: http://hdl.handle.net/10311/1642
ISSN: 0269-9370
Appears in Collections:Research articles (School of Medicine)

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