Reduced mortality and loss to follow-up in integrated compared with vertical programmes providing antiretroviral treatment in sub-Saharan Africa.
J Acquir Immune Defic Syndr. 2011 Nov 30;
Authors: Greig J, Oʼbrien D, Ford N, Spelman T, Sabapathy K, Shanks L
Abstract
BACKGROUND: Vertical HIV programmes have achieved good results but may not be feasible or appropriate in many resource-limited settings. Médecins sans Frontières has treated HIV in vertical programmes since 2000 and over time integrated HIV treatment into general healthcare services using simplified protocols. We analysed the survival probability among patients receiving antiretroviral therapy (ART) from 2003-2010 in integrated versus vertical programmes in nine countries in sub-Saharan Africa. METHODS: and Findings: Cox regression assessed mortality and programme design association, adjusting for baseline age, body mass index, clinical WHO stage, tuberculosis, programme age and setting. The analysis included 15403 HIV-positive adults on ART in seven vertical (14124 patients) and ten integrated (1279 patients) programmes. Cox regression including 14523 patients followed for up to 30 months ART showed similar outcomes for mortality (adjusted hazard ratios [aHR] 1.02; 95% CI0.83-1.24) and lower risk of loss to follow-up (aHR 0.71; 95% CI 0.61-0.83) in integrated compared with vertical programmes. The greatest risk of death was from initiating ART at WHO stage 4 (aHR 1.99, 95% CI 1.74-2.29), while greater programme experience was protective (aHR 0.77, 95% CI 0.66-0.89). Risk of loss to follow-up was greater in experienced programmes (aHR 3.33; 95% CI 2.92-3.79), and rural settings (aHR 3.82; 95% CI 3.49-4.20). CONCLUSIONS: ART delivery in integrated, general healthcare programmes results in good outcomes. Compared with vertical HIV programmes, patients initiated ART in integrated programmes at more advanced stages of clinical immunosuppression yet had similar risk of death and lower risk of loss to follow-up.
PMID: 22134144 [PubMed - as supplied by publisher]
References
- Greig J, Oʼbrien D, Ford N, Spelman T, Sabapathy K, Shanks L. Reduced mortality and loss to follow-up in integrated compared with vertical programmes providing antiretroviral treatment in sub-Saharan Africa. J Acquir Immune Defic Syndr. 2011 Nov 30. PMID: 22134144.
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