Cargando…
Socioeconomic position and ten-year survival and virologic outcomes in a Ugandan HIV cohort receiving antiretroviral therapy
Lifelong ART is essential to reducing HIV mortality and ending the epidemic, however the interplay between socioeconomic position and long-term outcomes of HIV-infected persons receiving antiretroviral therapy (ART) in sub-Saharan Africa is unknown. Furthering the understanding of factors related to...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731768/ https://www.ncbi.nlm.nih.gov/pubmed/29244807 http://dx.doi.org/10.1371/journal.pone.0189055 |
_version_ | 1783286566357041152 |
---|---|
author | Flynn, Andrew G. Anguzu, Godwin Mubiru, Frank Kiragga, Agnes N. Kamya, Moses Meya, David B. Boulware, David R. Kambugu, Andrew Castelnuovo, Barbara C. |
author_facet | Flynn, Andrew G. Anguzu, Godwin Mubiru, Frank Kiragga, Agnes N. Kamya, Moses Meya, David B. Boulware, David R. Kambugu, Andrew Castelnuovo, Barbara C. |
author_sort | Flynn, Andrew G. |
collection | PubMed |
description | Lifelong ART is essential to reducing HIV mortality and ending the epidemic, however the interplay between socioeconomic position and long-term outcomes of HIV-infected persons receiving antiretroviral therapy (ART) in sub-Saharan Africa is unknown. Furthering the understanding of factors related to long-term ART outcomes in this important region will aid the successful scale-up of ART programs. We enrolled 559 HIV-infected Ugandan adults starting ART in 2004–2005 at the Infectious Diseases Institute in Kampala, Uganda and followed them for 10 years. We documented baseline employment status, regular household income, education level, housing description, physical ability, and CD4 count. Viral load was measured every six months. Proportional hazard regression tested for associations between baseline characteristics and 1) mortality, 2) virologic failure, and 3) mortality or virologic failure as a composite outcome. Over ten years 23% (n = 127) of participants died, 6% (n = 31) were lost-to-follow-up and 23% (107/472) experienced virologic treatment failure. In Kaplan-Meier analysis we observed an association between employment and mortality, with the highest cumulative probability of death occurring in unemployed individuals. In univariate analysis unemployment and disease severity were associated with mortality, but in multivariable analysis the only association with mortality was disease severity. We observed an association between higher household income and an increased incidence of both virologic failure and the combined outcome, and an association between self-employment and lower incidence of virologic failure and the combined outcome when compared to unemployment. Formal education level and housing status were unrelated to outcomes. It is feasible to achieve good ten-year survival, retention-in-care, and viral suppression in a socioeconomically diverse population in a resource-limited setting. Unemployment appears to be related to adverse 10-year ART outcomes. A low level of formal education does not appear to be a barrier to successful long-term ART. |
format | Online Article Text |
id | pubmed-5731768 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-57317682017-12-22 Socioeconomic position and ten-year survival and virologic outcomes in a Ugandan HIV cohort receiving antiretroviral therapy Flynn, Andrew G. Anguzu, Godwin Mubiru, Frank Kiragga, Agnes N. Kamya, Moses Meya, David B. Boulware, David R. Kambugu, Andrew Castelnuovo, Barbara C. PLoS One Research Article Lifelong ART is essential to reducing HIV mortality and ending the epidemic, however the interplay between socioeconomic position and long-term outcomes of HIV-infected persons receiving antiretroviral therapy (ART) in sub-Saharan Africa is unknown. Furthering the understanding of factors related to long-term ART outcomes in this important region will aid the successful scale-up of ART programs. We enrolled 559 HIV-infected Ugandan adults starting ART in 2004–2005 at the Infectious Diseases Institute in Kampala, Uganda and followed them for 10 years. We documented baseline employment status, regular household income, education level, housing description, physical ability, and CD4 count. Viral load was measured every six months. Proportional hazard regression tested for associations between baseline characteristics and 1) mortality, 2) virologic failure, and 3) mortality or virologic failure as a composite outcome. Over ten years 23% (n = 127) of participants died, 6% (n = 31) were lost-to-follow-up and 23% (107/472) experienced virologic treatment failure. In Kaplan-Meier analysis we observed an association between employment and mortality, with the highest cumulative probability of death occurring in unemployed individuals. In univariate analysis unemployment and disease severity were associated with mortality, but in multivariable analysis the only association with mortality was disease severity. We observed an association between higher household income and an increased incidence of both virologic failure and the combined outcome, and an association between self-employment and lower incidence of virologic failure and the combined outcome when compared to unemployment. Formal education level and housing status were unrelated to outcomes. It is feasible to achieve good ten-year survival, retention-in-care, and viral suppression in a socioeconomically diverse population in a resource-limited setting. Unemployment appears to be related to adverse 10-year ART outcomes. A low level of formal education does not appear to be a barrier to successful long-term ART. Public Library of Science 2017-12-15 /pmc/articles/PMC5731768/ /pubmed/29244807 http://dx.doi.org/10.1371/journal.pone.0189055 Text en © 2017 Flynn et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Flynn, Andrew G. Anguzu, Godwin Mubiru, Frank Kiragga, Agnes N. Kamya, Moses Meya, David B. Boulware, David R. Kambugu, Andrew Castelnuovo, Barbara C. Socioeconomic position and ten-year survival and virologic outcomes in a Ugandan HIV cohort receiving antiretroviral therapy |
title | Socioeconomic position and ten-year survival and virologic outcomes in a Ugandan HIV cohort receiving antiretroviral therapy |
title_full | Socioeconomic position and ten-year survival and virologic outcomes in a Ugandan HIV cohort receiving antiretroviral therapy |
title_fullStr | Socioeconomic position and ten-year survival and virologic outcomes in a Ugandan HIV cohort receiving antiretroviral therapy |
title_full_unstemmed | Socioeconomic position and ten-year survival and virologic outcomes in a Ugandan HIV cohort receiving antiretroviral therapy |
title_short | Socioeconomic position and ten-year survival and virologic outcomes in a Ugandan HIV cohort receiving antiretroviral therapy |
title_sort | socioeconomic position and ten-year survival and virologic outcomes in a ugandan hiv cohort receiving antiretroviral therapy |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731768/ https://www.ncbi.nlm.nih.gov/pubmed/29244807 http://dx.doi.org/10.1371/journal.pone.0189055 |
work_keys_str_mv | AT flynnandrewg socioeconomicpositionandtenyearsurvivalandvirologicoutcomesinaugandanhivcohortreceivingantiretroviraltherapy AT anguzugodwin socioeconomicpositionandtenyearsurvivalandvirologicoutcomesinaugandanhivcohortreceivingantiretroviraltherapy AT mubirufrank socioeconomicpositionandtenyearsurvivalandvirologicoutcomesinaugandanhivcohortreceivingantiretroviraltherapy AT kiraggaagnesn socioeconomicpositionandtenyearsurvivalandvirologicoutcomesinaugandanhivcohortreceivingantiretroviraltherapy AT kamyamoses socioeconomicpositionandtenyearsurvivalandvirologicoutcomesinaugandanhivcohortreceivingantiretroviraltherapy AT meyadavidb socioeconomicpositionandtenyearsurvivalandvirologicoutcomesinaugandanhivcohortreceivingantiretroviraltherapy AT boulwaredavidr socioeconomicpositionandtenyearsurvivalandvirologicoutcomesinaugandanhivcohortreceivingantiretroviraltherapy AT kambuguandrew socioeconomicpositionandtenyearsurvivalandvirologicoutcomesinaugandanhivcohortreceivingantiretroviraltherapy AT castelnuovobarbarac socioeconomicpositionandtenyearsurvivalandvirologicoutcomesinaugandanhivcohortreceivingantiretroviraltherapy |