Using age-specific mortality of HIV infected persons to predict Anti-Retroviral Treatment need: a comparative analysis of data from five African population-based cohort studies.


Zaba, B; Kasamba, I; Floyd, S; Isingo, R; Herbst, K; Bärnighausen, T; Gregson, S; Nyamukapa, C; Kayuni, N; Todd, J; Marston, M; Wringe, A; (2012) Using age-specific mortality of HIV infected persons to predict Anti-Retroviral Treatment need: a comparative analysis of data from five African population-based cohort studies. Tropical medicine & international health, 17 (8). e3-e14. ISSN 1360-2276 DOI: https://doi.org/10.1111/j.1365-3156.2011.02943.x

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Abstract

: Objectives? To present a simple method for estimating population-level anti-retroviral therapy (ART) need that does not rely on knowledge of past HIV incidence. Methods? A new approach to estimating ART need is developed based on calculating age-specific proportions of HIV-infected adults expected to die within a fixed number of years in the absence of treatment. Mortality data for HIV-infected adults in the pre-treatment era from five African HIV cohort studies were combined to construct a life table, starting at age 15, smoothed with a Weibull model. Assuming that ART should be made available to anyone expected to die within 3?years, conditional 3-year survival probabilities were computed to represent proportions needing ART. The build-up of ART need in a successful programme continuously recruiting infected adults into treatment as they age to within 3?years of expected death was represented by annually extending the conditional survival range. Results? The Weibull model: survival probability in the infected state from age 15?=?exp(-0.0073?× (age?-?15)(1.69)) fitted the pooled age-specific mortality data very closely. Initial treatment need for infected persons increased rapidly with age, from 15% at age 20-24 to 32% at age 40-44 and 42% at age 60-64. Overall need in the treatment of naïve population was 24%, doubling within 5?years in a programme continually recruiting patients entering the high-risk period for dying. Conclusion? A reasonable projection of treatment need in an ART naive population can be made based on the age and gender profile of HIV-infected people.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Population Studies (1974-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: ALPHA Network
Population Studies Group
MEIRU
Tropical Epidemiology Group
PubMed ID: 22943377
Web of Science ID: 306955700002
URI: http://researchonline.lshtm.ac.uk/id/eprint/230625

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