Treatment Outcomes From the Largest Antiretroviral Treatment Program in Myanmar (Burma): A Cohort Analysis of Retention After Scale-Up


Sabapathy, K; Ford, N; Chan, KN; Kyaw, MK; Elema, R; Smithuis, F; Floyd, S; (2012) Treatment Outcomes From the Largest Antiretroviral Treatment Program in Myanmar (Burma): A Cohort Analysis of Retention After Scale-Up. Journal of acquired immune deficiency syndromes (1999), 60 (2). E53-E62. ISSN 1525-4135 DOI: https://doi.org/10.1097/QAI.0b013e31824d5689

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Abstract

Background: Antiretroviral treatment (ART) coverage in Myanmar is well below average. This study describes retention and baseline predictors of prognosis from the largest ART program in the country. Methods: A cohort analysis of adult patients who initiated ART during 2003-2007 was conducted, with follow-up until the end of 2009. The primary outcome was attrition [death plus losses to follow-up (LTF)]. Baseline variables were assessed as potential risk factors. The cumulative probabilities of death, LTF, and attrition up to 5 years were described using Kaplan-Meier estimates. Cox regression was used to calculate hazard ratios of attrition, overall and separately for 2 time periods on ART: 1-6 and 7-36 months. Results: A total of 5963 adults enrolled in the program, providing 17,581 person-years of follow-up. Median age at baseline was 33 years [interquartile range (IQR): 28-38], 61% were men, 45% were in World Health Organization stage IV, and the median CD4 count was 71 cells per cubic millimeter (IQR: 29-164). There were 821 (13.8%) deaths and 389 (6.5%) LTF over the study period, with a 72% probability of being retained in care in the 5-year cohort. Double the rate of loss was contributed by death compared with LTF, and attrition was almost 4 times higher in the period 1-6 months compared with 7-36 months. In the multivariable analyses of the program overall, older age [adjusted hazard ratio (aHR): 1.56, 95% confidence interval (CI): 1.25 to 1.94], being male (aHR: 1.52, 95% CI: 1.25 to 1.85), World Health Organization stage IV (aHR: 1.44, 95% CI: 1.19 to 1.74), and body mass index <16 kg/m(2) (aHR: 2.13, 95% CI: 1.71 to 2.66) were independently predictive of attrition. Conclusions: The excellent retention over >6 years in this large cohort demonstrates that ART delivery at the primary care level in Myanmar is feasible and should encourage support for further ART expansion in the country.

Item Type: Article
Keywords: antiretroviral treatment, HIV, predictors, risk factors, prognosis, attrition, retention, mortality, primary care, resource limited, Asia, Myanmar, Burma, cohort, hiv-infected patients, sub-saharan africa, therapy programs, income, countries, universal access, early mortality, rural district, south-africa, follow-up, malawi
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Population Studies Group
Tropical Epidemiology Group
PubMed ID: 22334069
Web of Science ID: 304436600005
URI: http://researchonline.lshtm.ac.uk/id/eprint/53838

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