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Trop Med Int Health. 2012 Apr;17(4):497-506. doi: 10.1111/j.1365-3156.2011.02952.x. Epub 2012 Feb 1.

Low mortality risk but high loss to follow-up among patients in the Tanzanian national HIV care and treatment programme.

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  • 1Epidemiology Unit, National AIDS Control Programme, Dar-es-Salaam, Tanzania.

Abstract

OBJECTIVE To analyse survival and retention rates of the Tanzanian care and treatment programme.

METHODS:

Routine patient-level data were available from 101 of 909 clinics. Kaplan-Meier probabilities of mortality and attrition after ART initiation were calculated. Mortality risks were corrected for biases from loss to follow-up using Egger's nomogram. Smoothed hazard rates showed mortality and attrition peaks. Cox regression identified factors associated with death and attrition. Median CD4 counts were calculated at 6 month intervals.

RESULTS:

In 88,875 adults, 18% were lost to follow up 12 months after treatment initiation, and 36% after 36 months. Cumulative mortality reached 10% by 12 months (15% after correcting for loss to follow-up) and 14% by 36 months. Mortality and attrition rates both peaked within the first six months, and were higher among males, those under 45 kg and those with CD4 counts below 50 cells/μl at ART initiation. In the first year on ART, median CD4 count increased by 126 cells/μl, with similar changes in both sexes.

CONCLUSION:

Earlier diagnoses through expanded HIV testing may reduce high mortality and attrition rates if combined with better patient tracing systems. Further research is needed to explore reasons for attrition.

© 2012 Blackwell Publishing Ltd.

PMID:
22296265
[PubMed - indexed for MEDLINE]
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