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

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dc.contributor.authorBakanda, Celestinen_ZA
dc.contributor.authorBirungi, Josephineen_ZA
dc.contributor.authorMwesigwa, Roberten_ZA
dc.contributor.authorNachega, Jean Ben_ZA
dc.contributor.authorChan, Keithen_ZA
dc.contributor.authorPalmer, Alexisen_ZA
dc.contributor.authorFord, Nathanen_ZA
dc.contributor.authorMills, Edward Jen_ZA
dc.date.accessioned2015-11-16T04:09:38Z
dc.date.available2015-11-16T04:09:38Z
dc.date.issued2011en_ZA
dc.description.abstractBACKGROUND: 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.identifier.apacitationBakanda, 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/11427/15000en_ZA
dc.identifier.chicagocitationBakanda, 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/11427/15000en_ZA
dc.identifier.citationBakanda, 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.0019261en_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
dc.identifier.urihttp://hdl.handle.net/11427/15000
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0019261
dc.identifier.vancouvercitationBakanda 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.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis 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.holder© 2011 Bakanda et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherAdolescentsen_ZA
dc.subject.otherDeath ratesen_ZA
dc.subject.otherUgandaen_ZA
dc.subject.otherAIDSen_ZA
dc.titleSurvival of HIV-infected adolescents on antiretroviral therapy in Uganda: findings from a nationally representative cohort in Ugandaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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