Survival of HIV-infected adolescents on antiretroviral therapy in Uganda: findings from a nationally representative cohort in Uganda

 

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dc.contributor.author Bakanda, Celestin en_ZA
dc.contributor.author Birungi, Josephine en_ZA
dc.contributor.author Mwesigwa, Robert en_ZA
dc.contributor.author Nachega, Jean B en_ZA
dc.contributor.author Chan, Keith en_ZA
dc.contributor.author Palmer, Alexis en_ZA
dc.contributor.author Ford, Nathan en_ZA
dc.contributor.author Mills, Edward J en_ZA
dc.date.accessioned 2015-11-16T04:09:38Z
dc.date.available 2015-11-16T04:09:38Z
dc.date.issued 2011 en_ZA
dc.identifier.citation Bakanda, C., Birungi, J., Mwesigwa, R., Nachega, J. B., Chan, K., Palmer, A., ... & Mills, E. J. (2011). Survival of HIV-infected adolescents on antiretroviral therapy in Uganda: findings from a nationally representative cohort in Uganda. PLoS One, 6(4), e19261. doi:10.1371/journal.pone.0019261 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/15000
dc.identifier.uri http://dx.doi.org/10.1371/journal.pone.0019261
dc.description.abstract BACKGROUND: Adolescents have been identified as a high-risk group for poor adherence to and defaulting from combination antiretroviral therapy (cART) care. However, data on outcomes for adolescents on cART in resource-limited settings remain scarce. METHODS: We developed an observational study of patients who started cART at The AIDS Service Organization (TASO) in Uganda between 2004 and 2009. Age was stratified into three groups: children (≤10 years), adolescents (11-19 years), and adults (≥20 years). Kaplan-Meier survival curves were generated to describe time to mortality and loss to follow-up, and Cox regression used to model associations between age and mortality and loss to follow-up. To address loss to follow up, we applied a weighted analysis that assumes 50% of lost patients had died. FINDINGS: A total of 23,367 patients were included in this analysis, including 810 (3.5%) children, 575 (2.5%) adolescents, and 21 982 (94.0%) adults. A lower percentage of children (5.4%) died during their cART treatment compared to adolescents (8.5%) and adults (10%). After adjusting for confounding, other features predicted mortality than age alone. Mortality was higher among males ( p <0.001), patients with a low initial CD4 cell count ( p <0.001), patients with advanced WHO clinical disease stage ( p <0.001), and shorter duration of time receiving cART ( p <0.001). The crude mortality rate was lower for children (22.8 per 1000 person-years; 95% CI: 16.1, 29.5), than adolescents (36.5 per 1000 person-years; 95% CI: 26.3, 46.8) and adults (37.5 per 1000 person-years; 95% CI: 35.9, 39.1). Interpretation This study is the largest assessment of adolescents receiving cART in Africa. Adolescents did not have cART mortality outcomes different from adults or children. en_ZA
dc.language.iso eng en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/4.0 en_ZA
dc.source PLoS One en_ZA
dc.source.uri http://journals.plos.org/plosone en_ZA
dc.subject.other Adolescents en_ZA
dc.subject.other Death rates en_ZA
dc.subject.other Uganda en_ZA
dc.subject.other AIDS en_ZA
dc.title Survival of HIV-infected adolescents on antiretroviral therapy in Uganda: findings from a nationally representative cohort in Uganda en_ZA
dc.type Journal Article en_ZA
dc.rights.holder © 2011 Bakanda et al en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Institute of Infectious Disease and Molecular Medicine en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Bakanda, C., Birungi, J., Mwesigwa, R., Nachega, J. B., Chan, K., Palmer, A., ... Mills, E. J. (2011). Survival of HIV-infected adolescents on antiretroviral therapy in Uganda: findings from a nationally representative cohort in Uganda. <i>PLoS One</i>, http://hdl.handle.net/11427/15000 en_ZA
dc.identifier.chicagocitation Bakanda, Celestin, Josephine Birungi, Robert Mwesigwa, Jean B Nachega, Keith Chan, Alexis Palmer, Nathan Ford, and Edward J Mills "Survival of HIV-infected adolescents on antiretroviral therapy in Uganda: findings from a nationally representative cohort in Uganda." <i>PLoS One</i> (2011) http://hdl.handle.net/11427/15000 en_ZA
dc.identifier.vancouvercitation Bakanda C, Birungi J, Mwesigwa R, Nachega JB, Chan K, Palmer A, et al. Survival of HIV-infected adolescents on antiretroviral therapy in Uganda: findings from a nationally representative cohort in Uganda. PLoS One. 2011; http://hdl.handle.net/11427/15000. en_ZA
dc.identifier.ris TY - Journal Article AU - Bakanda, Celestin AU - Birungi, Josephine AU - Mwesigwa, Robert AU - Nachega, Jean B AU - Chan, Keith AU - Palmer, Alexis AU - Ford, Nathan AU - Mills, Edward J AB - BACKGROUND: Adolescents have been identified as a high-risk group for poor adherence to and defaulting from combination antiretroviral therapy (cART) care. However, data on outcomes for adolescents on cART in resource-limited settings remain scarce. METHODS: We developed an observational study of patients who started cART at The AIDS Service Organization (TASO) in Uganda between 2004 and 2009. Age was stratified into three groups: children (≤10 years), adolescents (11-19 years), and adults (≥20 years). Kaplan-Meier survival curves were generated to describe time to mortality and loss to follow-up, and Cox regression used to model associations between age and mortality and loss to follow-up. To address loss to follow up, we applied a weighted analysis that assumes 50% of lost patients had died. FINDINGS: A total of 23,367 patients were included in this analysis, including 810 (3.5%) children, 575 (2.5%) adolescents, and 21 982 (94.0%) adults. A lower percentage of children (5.4%) died during their cART treatment compared to adolescents (8.5%) and adults (10%). After adjusting for confounding, other features predicted mortality than age alone. Mortality was higher among males ( p <0.001), patients with a low initial CD4 cell count ( p <0.001), patients with advanced WHO clinical disease stage ( p <0.001), and shorter duration of time receiving cART ( p <0.001). The crude mortality rate was lower for children (22.8 per 1000 person-years; 95% CI: 16.1, 29.5), than adolescents (36.5 per 1000 person-years; 95% CI: 26.3, 46.8) and adults (37.5 per 1000 person-years; 95% CI: 35.9, 39.1). Interpretation This study is the largest assessment of adolescents receiving cART in Africa. Adolescents did not have cART mortality outcomes different from adults or children. DA - 2011 DB - OpenUCT DO - 10.1371/journal.pone.0019261 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2011 T1 - Survival of HIV-infected adolescents on antiretroviral therapy in Uganda: findings from a nationally representative cohort in Uganda TI - Survival of HIV-infected adolescents on antiretroviral therapy in Uganda: findings from a nationally representative cohort in Uganda UR - http://hdl.handle.net/11427/15000 ER - en_ZA


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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Except where otherwise noted, this item's license is described as This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.