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Are death and loss to follow-up still high in people living with HIV on ART after national scale-up and earlier treatment initiation? A large cohort study in government hospital-based setting, Myanmar: 2013-2016.
Aung, Zaw Zaw; Oo, Myo Minn; Tripathy, Jaya Prasad; Kyaw, Nang Thu Thu; Hone, San; Oo, Htun Nyunt; Majumdar, Suman S.
Affiliation
  • Aung ZZ; National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar.
  • Oo MM; International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar.
  • Tripathy JP; International Union Against Tuberculosis and Lung Disease, South East Asia Regional Office, New Delhi, India.
  • Kyaw NTT; International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar.
  • Hone S; National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar.
  • Oo HN; National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar.
  • Majumdar SS; Burnet Institute, Melbourne, Australia.
PLoS One ; 13(9): e0204550, 2018.
Article in En | MEDLINE | ID: mdl-30252904
ABSTRACT

SETTING:

Myanmar National AIDS Program has had significant scale-up of services and changes in CD4 eligibility criterion for ART initiation from 2013 to 2016. This study assessed early death within 6 months and attrition (death and loss to follow-up, LTFU) after ART initiation and their associated factors.

DESIGN:

A retrospective cohort study on people living with HIV (PLHIV >15 year of age) enrolled at three specialist hospitals in Yangon from 1st June 2013 to 30th June 2016. Cox regression was used to calculate hazard ratios (HRs) of early death and attrition.

RESULTS:

Of 11,727 adults enrolled, 11,186 (95%) were initiated on ART, providing 15,964 person-years of follow-up. At baseline, median age was 36 years [IQR 30-43], 58% were men and median CD4 count was 151 cells/mm3 (IQR 54-310). There were 733(6%) early deaths, 961(9%) total deaths and 1371 (12%) LTFU during the study period. Independent risk factors for early death were older age (41-50 and ≥51 years) [aHR 1.38, 1.07-1.78 and 1.68, 1.21-2.34], male (1.84, 1.44-2.35), low weight (2.06, 1.64-2.59), bedridden, (3.81, 2.57-5.66) and CD4 count ≤ 50 cells/mm3 (6.83, 2.52-18.57). In addition to above factors, high attrition was associated with an abacavir-based regimen.

CONCLUSION:

Although there was a low rate of early deaths, patients were being diagnosed late and there was a high attrition rate from specialist hospitals. Concerted effort is required to increase early diagnosis and ART initiation, and strengthen community systems for HIV care to achieve ambitious goal of ending AIDS epidemic by 2030.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: HIV Infections / Anti-HIV Agents Type of study: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies / Screening_studies Limits: Adult / Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: En Journal: PLoS One Journal subject: CIENCIA / MEDICINA Year: 2018 Document type: Article Affiliation country:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: HIV Infections / Anti-HIV Agents Type of study: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies / Screening_studies Limits: Adult / Female / Humans / Male / Middle aged Country/Region as subject: Asia Language: En Journal: PLoS One Journal subject: CIENCIA / MEDICINA Year: 2018 Document type: Article Affiliation country: