Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2009

Open Access 01-12-2009 | Research article

Mortality and loss-to-follow-up during the pre-treatment period in an antiretroviral therapy programme under normal health service conditions in Uganda

Authors: Barbara Amuron, Geoffrey Namara, Josephine Birungi, Christine Nabiryo, Jonathan Levin, Heiner Grosskurth, Alex Coutinho, Shabbar Jaffar

Published in: BMC Public Health | Issue 1/2009

Login to get access

Abstract

Background

In many HIV programmes in Africa, patients are assessed clinically and prepared for antiretroviral treatment over a period of 4–12 weeks. Mortality rates following initiation of ART are very high largely because patients present late with advanced disease. The rates of mortality and retention during the pre-treatment period are not well understood. We conducted an observational study to determine these rates.

Methods

HIV-infected subjects presenting at The AIDS Support Clinic in Jinja, SE Uganda, were assessed for antiretroviral therapy (ART). Eligible subjects were given information and counselling in 3 visits done over 4–6 weeks in preparation for treatment. Those who did not complete screening were followed-up at home. Survival analysis was done using poisson regression.

Results

4321 HIV-infected subjects were screened of whom 2483 were eligible for ART on clinical or immunological grounds. Of these, 637 (26%) did not complete screening and did not start ART. Male sex and low CD4 count were associated independently with not completing screening. At follow-up at a median 351 days, 181 (28%) had died, 189 (30%) reported that they were on ART with a different provider, 158 (25%) were alive but said they were not on ART and 109 (17%) were lost to follow-up. Death rates (95% CI) per 100 person-years were 34 (22, 55) (n.18) within one month and 37 (29, 48) (n.33) within 3 months. 70/158 (44%) subjects seen at follow-up said they had not started ART because they could not afford transport.

Conclusion

About a quarter of subjects eligible for ART did not complete screening and pre-treatment mortality was very high even though patients in this setting were well informed. For many families, the high cost of transport is a major barrier preventing access to ART.
Appendix
Available only for authorised users
Literature
1.
World Health Organization: Towards Universal Access: Scaling up priority HIV/AIDS in the health sector. Progress report. 2007, 10.1097/01.aids.0000226959.87471.01.
2.
Etard JF, Ndiaye I, Thierry-Mieg M, Gueye NF, Gueye PM, Laniece I, Dieng AB, Diouf A, Laurent C, Mboup S, Sow PS, Delaporte E: Mortality and causes of death in adults receiving highly active antiretroviral therapy in Senegal: a 7-year cohort study. AIDS. 2006, 20: 1181-9. 10.1111/j.1365-3156.2008.02131.x.CrossRefPubMed
3.
Jaffar S, Munderi P, Grosskurth H: Adherence to antiretroviral therapy in Africa: how high is it really?. Trop Med Int Health. 2008, 13: 1096-7. 10.1016/S0140-6736(08)60345-1.CrossRefPubMed
4.
Mermin J, Were W, Ekwaru JP, Moore D, Downing R, Behumbiize P, Lule JR, Coutinho A, Tappero J, Bunnell R: Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: a prospective cohort study. Lancet. 2008, 371: 752-9. 10.1001/jama.296.7.782.CrossRefPubMed
5.
Stringer JS, Zulu I, Levy J, Stringer EM, Mwango A, Chi BH, Mtonga V, Reid S, Cantrell RA, Bulterys M, Saag MS, Marlink RG, Mwinga A, Ellerbrock TV, Sinkala M: Rapid scale-up of antiretroviral therapy at primary care sites in Zambia: feasibility and early outcomes. JAMA. 2006, 296: 782-93. 10.1016/S0140-6736(06)68337-2.CrossRefPubMed
6.
Braitstein P, Brinkhof MW, Dabis F, Schechter M, Boulle A, Miotti P, Wood R, Laurent C, Sprinz E, Seyler C, Bangsberg DR, Balestre E, Sterne JA, May M, Egger M: Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries. Lancet. 2006, 367: 817-24. 10.1089/aid.2007.0217.CrossRefPubMed
7.
Marazzi MC, Liotta G, Germano P, Guidotti G, Altan AD, Ceffa S, Lio MM, Nielsen-Saines K, Palombi L: Excessive early mortality in the first year of treatment in HIV type 1-infected patients initiating antiretroviral therapy in resource-limited settings. AIDS Res Hum Retroviruses. 2008, 24: 555-60. 10.1089/aid.2007.0217.CrossRefPubMed
8.
Jaffar S, Grant AD, Whitworth J, Smith PG, Whittle H: The natural history of HIV-1 and HIV-2 infections in adults in Africa: a literature review. Bull World Health Organ. 2004, 82: 462-9.PubMedPubMedCentral
9.
Antiretroviral therapy in resource-limited settings 1996 to 2006: patient characteristics, treatment regimens and monitoring in sub-Saharan Africa, Asia and Latin America. Trop Med Int Health. 2008, 13: 870-879. 10.1097/QAD.0b013e32830007cd.
10.
Lawn SD, Harries AD, Anglaret X, Myer L, Wood R: Early mortality among adults accessing antiretroviral treatment programmes in sub-Saharan Africa. AIDS. 2008, 22: 1897-908. 10.1371/journal.pmed.0040298.CrossRefPubMed
11.
Rosen S, Fox MP, Gill CJ: Patient retention in antiretroviral therapy programs in sub-Saharan Africa: a systematic review. PLoS Med. 2007, 4: e298-10.2174/1874613600701010021.CrossRefPubMedPubMedCentral
12.
Amuron B, Coutinho A, Grosskurth H, Nabiryo C, Birungi J, Namara G, Levin J, Smith PG, Jaffar S: A cluster-randomised trial to compare home-based with health facility-based antiretroviral treatment in Uganda: study design and baseline findings. Open AIDS J. 2007, 1: 21-7. 10.1001/archinternmed.2007.10.CrossRefPubMedPubMedCentral
13.
Fairall LR, Bachmann MO, Louwagie GM, van Vuuren C, Chikobvu P, Steyn D, Staniland GH, Timmerman V, Msimanga M, Seebregts CJ, Boulle A, Nhiwatiwa R, Bateman ED, Zwarenstein MF, Chapman RD: Effectiveness of antiretroviral treatment in a South African program: a cohort study. Arch Intern Med. 2008, 168: 86-93. 10.1086/507095.CrossRefPubMed
14.
Lawn SD, Myer L, Harling G, Orrell C, Bekker LG, Wood R: Determinants of mortality and nondeath losses from an antiretroviral treatment service in South Africa: implications for program evaluation. Clin Infect Dis. 2006, 43: 770-6. 10.1086/507095.CrossRefPubMed
15.
Lawn SD, Myer L, Orrell C, Bekker LG, Wood R: Early mortality among adults accessing a community-based antiretroviral service in South Africa: implications for programme design. AIDS. 2005, 19: 2141-8. 10.1111/j.1365-3156.2008.02131.x.CrossRefPubMed
16.
Jaffar S, Amuron B, Birungi J, Namara G, Nabiryo C, Coutinho A, Grosskurth H: Integrating research into routine service delivery in an antiretroviral treatment programme: lessons learnt from a cluster randomized trial comparing strategies of HIV care in Jinja, Uganda. Trop Med Int Health. 2008, 13: 795-800. 10.1186/1742-6405-5-4.CrossRefPubMed
17.
Jaffar S, Birungi J, Grosskurth H, Amuron B, Namara G, Nabiryo C, Coutinho A: Use of WHO clinical stage for assessing patient eligibility to antiretroviral therapy in a routine health service setting in Jinja, Uganda. AIDS Res Ther. 2008, 5: 4-10.1186/1742-6405-4-1.CrossRefPubMedPubMedCentral
18.
Moore DM, Awor A, Downing RS, Were W, Solberg P, Tu D, Chan K, Hogg RS, Mermin J: Determining eligibility for antiretroviral therapy in resource-limited settings using total lymphocyte counts, hemoglobin and body mass index. AIDS Res Ther. 2007, 4: 1-10.1186/1742-6405-4-1.CrossRefPubMedPubMedCentral
Metadata
Title
Mortality and loss-to-follow-up during the pre-treatment period in an antiretroviral therapy programme under normal health service conditions in Uganda
Authors
Barbara Amuron
Geoffrey Namara
Josephine Birungi
Christine Nabiryo
Jonathan Levin
Heiner Grosskurth
Alex Coutinho
Shabbar Jaffar
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2009
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-9-290

Other articles of this Issue 1/2009

BMC Public Health 1/2009 Go to the issue

Study protocol

Understanding the Relationship between Activity and Neighbourhoods (URBAN) Study: research design and methodology

Research article

Smoking, drinking and body weight after re-employment: does unemployment experience and compensation make a difference?

Research article

Contribution of parental and school personnel smoking to health risk behaviours among Finnish adolescents

Research article

Hemoglobin levels and anemia evaluation during pregnancy in the highlands of Tibet: a hospital-based study

Research article

Is the association between acne and mental distress influenced by diet? Results from a cross-sectional population study among 3775 late adolescents in Oslo, Norway

Research article

Increasing colon cancer testing in rural Colorado: evaluation of the exposure to a community-based awareness campaign