TY - JOUR
T1 - Retention and mortality on antiretroviral therapy in sub-Saharan Africa
T2 - Collaborative analyses of HIV treatment programmes: Collaborative
AU - Haas, Andreas D.
AU - Zaniewski, Elizabeth
AU - Anderegg, Nanina
AU - Ford, Nathan
AU - Fox, Matthew P.
AU - Vinikoor, Michael
AU - Dabis, François
AU - Nash, Denis
AU - Sinayobye, Jean D.Amour
AU - Niyongabo, Thêodore
AU - Tanon, Aristophane
AU - Poda, Armel
AU - Adedimeji, Adebola A.
AU - Edmonds, Andrew
AU - Davies, Mary Ann
AU - Egger, Matthias
N1 - Funding Information:
The African regions of the International epidemiology Databases to Evaluate AIDS (IeDEA) are supported by the National Cancer Institute (NCI), the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Mental Health (NIMH), and the National Institute on Drug Abuse (NIDA) as part of IeDEA (grants 5U01AI069919-04, 5U01-AI069924-05, 1U01 AI069927, and U01AI069911-01). This study was also supported by the Bill and Melinda Gates Foundation through the Measurement and Surveillance of HIV epidemics (MESH) consortium. MPF was funded through Cooperative Agreement AID 674-A-12-00029 from the United States Agency for International Development.
Publisher Copyright:
© 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.
PY - 2018/2
Y1 - 2018/2
N2 - Introduction: By 2020, 90% of all people diagnosed with HIV should receive long-term combination antiretroviral therapy (ART). In sub-Saharan Africa, this target is threatened by loss to follow-up in ART programmes. The proportion of people retained on ART long-term cannot be easily determined, because individuals classified as lost to follow-up, may have self-transferred to another HIV treatment programme, or may have died. We describe retention on ART in sub-Saharan Africa, first based on observed data as recorded in the clinic databases, and second adjusted for undocumented deaths and self-transfers. Methods: We analysed data from HIV-infected adults and children initiating ART between 2009 and 2014 at a sub-Saharan African HIV treatment programme participating in the International epidemiology Databases to Evaluate AIDS (IeDEA). We used the Kaplan-Meier method to calculate the cumulative incidence of retention on ART and the Aalen-Johansen method to calculate the cumulative incidences of death, loss to follow-up, and stopping ART. We used inverse probability weighting to adjust clinic data for undocumented mortality and self-transfer, based on estimates from a recent systematic review and meta-analysis. Results: We included 505,634 patients: 12,848 (2.5%) from Central Africa, 109,233 (21.6%) from East Africa, 347,343 (68.7%) from Southern Africa and 36,210 (7.2%) from West Africa. In crude analyses of observed clinic data, 52.1% of patients were retained on ART, 41.8% were lost to follow-up and 6.0% had died 5 years after ART initiation. After accounting for undocumented deaths and self-transfers, we estimated that 66.6% of patients were retained on ART, 18.8% had stopped ART and 14.7% had died at 5 years. Conclusions: Improving long-term retention on ART will be crucial to attaining the 90% on ART target. Naïve analyses of HIV cohort studies, which do not account for undocumented mortality and self-transfer of patients, may severely underestimate both mortality and retention on ART.
AB - Introduction: By 2020, 90% of all people diagnosed with HIV should receive long-term combination antiretroviral therapy (ART). In sub-Saharan Africa, this target is threatened by loss to follow-up in ART programmes. The proportion of people retained on ART long-term cannot be easily determined, because individuals classified as lost to follow-up, may have self-transferred to another HIV treatment programme, or may have died. We describe retention on ART in sub-Saharan Africa, first based on observed data as recorded in the clinic databases, and second adjusted for undocumented deaths and self-transfers. Methods: We analysed data from HIV-infected adults and children initiating ART between 2009 and 2014 at a sub-Saharan African HIV treatment programme participating in the International epidemiology Databases to Evaluate AIDS (IeDEA). We used the Kaplan-Meier method to calculate the cumulative incidence of retention on ART and the Aalen-Johansen method to calculate the cumulative incidences of death, loss to follow-up, and stopping ART. We used inverse probability weighting to adjust clinic data for undocumented mortality and self-transfer, based on estimates from a recent systematic review and meta-analysis. Results: We included 505,634 patients: 12,848 (2.5%) from Central Africa, 109,233 (21.6%) from East Africa, 347,343 (68.7%) from Southern Africa and 36,210 (7.2%) from West Africa. In crude analyses of observed clinic data, 52.1% of patients were retained on ART, 41.8% were lost to follow-up and 6.0% had died 5 years after ART initiation. After accounting for undocumented deaths and self-transfers, we estimated that 66.6% of patients were retained on ART, 18.8% had stopped ART and 14.7% had died at 5 years. Conclusions: Improving long-term retention on ART will be crucial to attaining the 90% on ART target. Naïve analyses of HIV cohort studies, which do not account for undocumented mortality and self-transfer of patients, may severely underestimate both mortality and retention on ART.
KW - antiretroviral therapy
KW - loss to follow-up
KW - mortality
KW - retention
KW - sub-Saharan Africa
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U2 - 10.1002/jia2.25084
DO - 10.1002/jia2.25084
M3 - Article
C2 - 29479867
AN - SCOPUS:85042714297
SN - 1758-2652
VL - 21
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
IS - 2
M1 - e25084
ER -
