Research Summary: Four-Year Treatment Outcomes of Adult Patients Enrolled in Mozambique’s Rapidly Expanding Antiretroviral Therapy Program

ABSTRACT

Background

In Mozambique during 2004–2007 numbers of adult patients (≥15 years
old) enrolled on antiretroviral therapy (ART) increased about 16-fold, from
<5,000 to 79,500. All ART patients were eligible for co-trimoxazole. ART
program outcomes, and determinants of outcomes, have not yet been
reported.


Methodology/Principal Findings

In a retrospective cohort study, we investigated rates of mortality,
attrition (death, loss to follow-up, or treatment cessation), immunologic
treatment failure, and regimen-switch, as well as determinants of selected
outcomes, among a nationally representative sample of 2,596 adults
initiating ART during 2004–2007. At ART initiation, median age of
patients was 34 and 62% were female. Malnutrition and advanced
disease were common; 18% of patients weighed <45 kilograms, and
15% were WHO stage IV. Median baseline CD4+ T-cell
count was 153/µL and was lower for males than females (139/µL
vs. 159/µL, p<0.01). Stavudine, lamivudine, and nevirapine or
efavirenz were prescribed to 88% of patients; only 31% were
prescribed co-trimoxazole. Mortality and attrition rates were 3.4 deaths and
19.8 attritions per 100 patient-years overall, and 12.9 deaths and 57.2
attritions per 100 patient-years in the first 90 days. Predictors of
attrition included male sex [adjusted hazard ratio (AHR) 1.5;
95% confidence interval (CI), 1.3–1.8], weight <45 kg
(AHR 2.1; 95% CI, 1.6–2.9, reference group >60 kg), WHO
stage IV (AHR 1.7; 95% CI, 1.3–2.4, reference group WHO stage
I/II), lack of co-trimoxazole prescription (AHR 1.4; 95% CI,
1.0–1.8), and later calendar year of ART initiation (AHR 1.5;
95% CI, 1.2–1.8). Rates of immunologic treatment failure and
regimen-switch were 14.0 and 0.6 events per 100-patient years,
respectively.


Conclusions

ART initiation at earlier disease stages and scale-up of co-trimoxazole among
ART patients could improve outcomes. Research to determine reasons for low
regimen-switch rates and increasing rates of attrition during program
expansion is needed.

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Publisher: Public Library of Science

Date Published: 4-April-2011

Author(s): Auld A., Mbofana F., Shiraishi R., Sanchez M., Alfredo C., Nelson L., Ellerbrock T.

Link: https://doi.org/10.1371/journal.pone.0018453

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