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Trends in the clinical characteristics of HIV-infected patients initiating antiretroviral therapy in Kenya, Uganda and Tanzania between 2002 and 2009

BACKGROUND: East Africa has experienced a rapid expansion in access to antiretroviral therapy (ART) for HIV-infected patients. Regionally representative socio-demographic, laboratory and clinical characteristics of patients accessing ART over time and across sites have not been well described. METHO...

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Autores principales: Geng, Elvin H, Hunt, Peter W, Diero, Lameck O, Kimaiyo, Sylvester, Somi, Geofrey R, Okong, Pius, Bangsberg, David R, Bwana, Mwebesa B, Cohen, Craig R, Otieno, Juliana A, Wabwire, Deo, Elul, Batya, Nash, Denis, Easterbrook, Philippa J, Braitstein, Paula, Musick, Beverly S, Martin, Jeffrey N, Yiannoutsos, Constantin T, Wools-Kaloustian, Kara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The International AIDS Society 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204275/
https://www.ncbi.nlm.nih.gov/pubmed/21955541
http://dx.doi.org/10.1186/1758-2652-14-46
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author Geng, Elvin H
Hunt, Peter W
Diero, Lameck O
Kimaiyo, Sylvester
Somi, Geofrey R
Okong, Pius
Bangsberg, David R
Bwana, Mwebesa B
Cohen, Craig R
Otieno, Juliana A
Wabwire, Deo
Elul, Batya
Nash, Denis
Easterbrook, Philippa J
Braitstein, Paula
Musick, Beverly S
Martin, Jeffrey N
Yiannoutsos, Constantin T
Wools-Kaloustian, Kara
author_facet Geng, Elvin H
Hunt, Peter W
Diero, Lameck O
Kimaiyo, Sylvester
Somi, Geofrey R
Okong, Pius
Bangsberg, David R
Bwana, Mwebesa B
Cohen, Craig R
Otieno, Juliana A
Wabwire, Deo
Elul, Batya
Nash, Denis
Easterbrook, Philippa J
Braitstein, Paula
Musick, Beverly S
Martin, Jeffrey N
Yiannoutsos, Constantin T
Wools-Kaloustian, Kara
author_sort Geng, Elvin H
collection PubMed
description BACKGROUND: East Africa has experienced a rapid expansion in access to antiretroviral therapy (ART) for HIV-infected patients. Regionally representative socio-demographic, laboratory and clinical characteristics of patients accessing ART over time and across sites have not been well described. METHODS: We conducted a cross-sectional analysis of characteristics of HIV-infected adults initiating ART between 2002 and 2009 in Kenya, Uganda and Tanzania and in the International Epidemiologic Databases to Evaluate AIDS Consortium. Characteristics associated with advanced disease (defined as either a CD4 cell count level of less than 50 cells/mm(3 )or a WHO Stage 4 condition) at the time of ART initiation and use of stavudine (D4T) or nevirapine (NVP) were identified using a log-link Poisson model with robust standard errors. RESULTS: Among 48, 658 patients (69% from Kenya, 22% from Uganda and 9% from Tanzania) accessing ART at 30 clinic sites, the median age at the time of ART initiation was 37 years (IQR: 31-43) and 65% were women. Pre-therapy CD4 counts rose from 87 cells/mm(3 )(IQR: 26-161) in 2002-03 to 154 cells/mm(3 )(IQR: 71-233) in 2008-09 (p < 0.001). Accessing ART at advanced disease peaked at 35% in 2005-06 and fell to 27% in 2008-09. D4T use in the initial regimen fell from a peak of 88% in 2004-05 to 59% in 2008-09, and a greater extent of decline was observed in Uganda than in Kenya and Tanzania. Self-pay for ART peaked at 18% in 2003, but fell to less than 1% by 2005. In multivariable analyses, accessing ART at advanced immunosuppression was associated with male sex, women without a history of treatment for prevention of mother to child transmission (both as compared with women with such a history) and younger age after adjusting for year of ART initiation and country of residence. Receipt of D4T in the initial regimen was associated with female sex, earlier year of ART initiation, higher WHO stage, and lower CD4 levels at ART initiation and the absence of co-prevalent tuberculosis. CONCLUSIONS: Public health ART services in east Africa have improved over time, but the fraction of patients accessing ART with advanced immunosuppression is still high, men consistently access ART with more advanced disease, and D4T continues to be common in most settings. Strategies to facilitate access to ART, overcome barriers among men and reduce D4T use are needed.
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spelling pubmed-32042752011-10-30 Trends in the clinical characteristics of HIV-infected patients initiating antiretroviral therapy in Kenya, Uganda and Tanzania between 2002 and 2009 Geng, Elvin H Hunt, Peter W Diero, Lameck O Kimaiyo, Sylvester Somi, Geofrey R Okong, Pius Bangsberg, David R Bwana, Mwebesa B Cohen, Craig R Otieno, Juliana A Wabwire, Deo Elul, Batya Nash, Denis Easterbrook, Philippa J Braitstein, Paula Musick, Beverly S Martin, Jeffrey N Yiannoutsos, Constantin T Wools-Kaloustian, Kara J Int AIDS Soc Research BACKGROUND: East Africa has experienced a rapid expansion in access to antiretroviral therapy (ART) for HIV-infected patients. Regionally representative socio-demographic, laboratory and clinical characteristics of patients accessing ART over time and across sites have not been well described. METHODS: We conducted a cross-sectional analysis of characteristics of HIV-infected adults initiating ART between 2002 and 2009 in Kenya, Uganda and Tanzania and in the International Epidemiologic Databases to Evaluate AIDS Consortium. Characteristics associated with advanced disease (defined as either a CD4 cell count level of less than 50 cells/mm(3 )or a WHO Stage 4 condition) at the time of ART initiation and use of stavudine (D4T) or nevirapine (NVP) were identified using a log-link Poisson model with robust standard errors. RESULTS: Among 48, 658 patients (69% from Kenya, 22% from Uganda and 9% from Tanzania) accessing ART at 30 clinic sites, the median age at the time of ART initiation was 37 years (IQR: 31-43) and 65% were women. Pre-therapy CD4 counts rose from 87 cells/mm(3 )(IQR: 26-161) in 2002-03 to 154 cells/mm(3 )(IQR: 71-233) in 2008-09 (p < 0.001). Accessing ART at advanced disease peaked at 35% in 2005-06 and fell to 27% in 2008-09. D4T use in the initial regimen fell from a peak of 88% in 2004-05 to 59% in 2008-09, and a greater extent of decline was observed in Uganda than in Kenya and Tanzania. Self-pay for ART peaked at 18% in 2003, but fell to less than 1% by 2005. In multivariable analyses, accessing ART at advanced immunosuppression was associated with male sex, women without a history of treatment for prevention of mother to child transmission (both as compared with women with such a history) and younger age after adjusting for year of ART initiation and country of residence. Receipt of D4T in the initial regimen was associated with female sex, earlier year of ART initiation, higher WHO stage, and lower CD4 levels at ART initiation and the absence of co-prevalent tuberculosis. CONCLUSIONS: Public health ART services in east Africa have improved over time, but the fraction of patients accessing ART with advanced immunosuppression is still high, men consistently access ART with more advanced disease, and D4T continues to be common in most settings. Strategies to facilitate access to ART, overcome barriers among men and reduce D4T use are needed. The International AIDS Society 2011-09-28 /pmc/articles/PMC3204275/ /pubmed/21955541 http://dx.doi.org/10.1186/1758-2652-14-46 Text en Copyright ©2011 Geng et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Geng, Elvin H
Hunt, Peter W
Diero, Lameck O
Kimaiyo, Sylvester
Somi, Geofrey R
Okong, Pius
Bangsberg, David R
Bwana, Mwebesa B
Cohen, Craig R
Otieno, Juliana A
Wabwire, Deo
Elul, Batya
Nash, Denis
Easterbrook, Philippa J
Braitstein, Paula
Musick, Beverly S
Martin, Jeffrey N
Yiannoutsos, Constantin T
Wools-Kaloustian, Kara
Trends in the clinical characteristics of HIV-infected patients initiating antiretroviral therapy in Kenya, Uganda and Tanzania between 2002 and 2009
title Trends in the clinical characteristics of HIV-infected patients initiating antiretroviral therapy in Kenya, Uganda and Tanzania between 2002 and 2009
title_full Trends in the clinical characteristics of HIV-infected patients initiating antiretroviral therapy in Kenya, Uganda and Tanzania between 2002 and 2009
title_fullStr Trends in the clinical characteristics of HIV-infected patients initiating antiretroviral therapy in Kenya, Uganda and Tanzania between 2002 and 2009
title_full_unstemmed Trends in the clinical characteristics of HIV-infected patients initiating antiretroviral therapy in Kenya, Uganda and Tanzania between 2002 and 2009
title_short Trends in the clinical characteristics of HIV-infected patients initiating antiretroviral therapy in Kenya, Uganda and Tanzania between 2002 and 2009
title_sort trends in the clinical characteristics of hiv-infected patients initiating antiretroviral therapy in kenya, uganda and tanzania between 2002 and 2009
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204275/
https://www.ncbi.nlm.nih.gov/pubmed/21955541
http://dx.doi.org/10.1186/1758-2652-14-46
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