Trends in one-year cumulative incidence of death between 2005 and 2013 among patients initiating antiretroviral therapy in Uganda

Lisa M. Bebell, Mark J. Siedner, Nicholas Musinguzi, Yap Boum, Bosco M. Bwana, Winnie Muyindike, Peter W. Hunt, Jeffrey N. Martin, David Bangsberg

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Recent ecological data demonstrate improving outcomes for HIV-infected people in sub-Saharan Africa. Recently, Uganda has experienced a resurgence in HIV incidence and prevalence, but trends in HIV-related deaths have not been well described. Data were collected through the Uganda AIDS Rural Treatment Outcomes (UARTO) Study, an observational longitudinal cohort of Ugandan adults initiating antiretroviral therapy (ART) between 2005 and 2013. We calculated cumulative incidence of death within one year of ART initiation, and fit Poisson models with robust variance estimators to estimate the effect enrollment period on one-year risk of death and loss to follow-up. Of 760 persons in UARTO who started ART, 30 deaths occurred within one year of ART initiation (cumulative incidence 3.9%, 95% confidence interval [CI] 2.7–5.6%). Risk of death was highest for those starting ART in 2005 (13.0%, 95% CI 6.0–24.0%), decreased in 2006–2007 to 4% (95% CI 2.0–6.0%), and did not change thereafter (P = 0.61). These results were robust to adjustment for age, sex, CD4 cell count, viral load, asset wealth, baseline depression, and body mass index. Here, we demonstrate that one-year cumulative incidence of death was high just after free ART rollout, decreased the following year, and remained low thereafter. Once established, ART programs in President’s Emergency Fund for AIDS Relief-supported countries can maintain high quality care.

Original languageEnglish (US)
Pages (from-to)800-807
Number of pages8
JournalInternational Journal of STD and AIDS
Volume28
Issue number8
DOIs
StatePublished - Jul 1 2017
Externally publishedYes

Fingerprint

Uganda
Incidence
Acquired Immunodeficiency Syndrome
HIV
Confidence Intervals
Therapeutics
Africa South of the Sahara
Quality of Health Care
CD4 Lymphocyte Count
Viral Load
Body Mass Index
Emergencies
Outcome Assessment (Health Care)

Keywords

  • Africa
  • antiretroviral
  • antiretroviral therapy
  • clinical outcomes
  • Death
  • early
  • HIV
  • mortality

ASJC Scopus subject areas

  • Dermatology
  • Public Health, Environmental and Occupational Health
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Trends in one-year cumulative incidence of death between 2005 and 2013 among patients initiating antiretroviral therapy in Uganda. / Bebell, Lisa M.; Siedner, Mark J.; Musinguzi, Nicholas; Boum, Yap; Bwana, Bosco M.; Muyindike, Winnie; Hunt, Peter W.; Martin, Jeffrey N.; Bangsberg, David.

In: International Journal of STD and AIDS, Vol. 28, No. 8, 01.07.2017, p. 800-807.

Research output: Contribution to journalArticle

Bebell, Lisa M. ; Siedner, Mark J. ; Musinguzi, Nicholas ; Boum, Yap ; Bwana, Bosco M. ; Muyindike, Winnie ; Hunt, Peter W. ; Martin, Jeffrey N. ; Bangsberg, David. / Trends in one-year cumulative incidence of death between 2005 and 2013 among patients initiating antiretroviral therapy in Uganda. In: International Journal of STD and AIDS. 2017 ; Vol. 28, No. 8. pp. 800-807.
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