Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: a prospective cohort study
ABSTRACT Antiretroviral therapy (ART) is increasingly available in Africa, but physicians and clinical services are few. We therefore assessed the effect of a home-based ART programme in Uganda on mortality, hospital admissions, and orphanhood in people with HIV-1 and their household members.
In 2001, we enrolled and followed up 466 HIV-infected adults and 1481 HIV-uninfected household members in a prospective cohort study. After 5 months, we provided daily co-trimoxazole (160 mg trimethoprim and 800 mg sulfamethoxazole) prophylaxis to HIV-infected participants. Between May, 2003, and December, 2005, we followed up 138 infected adults who were eligible and 907 new HIV-infected participants and their HIV-negative household members in a study of ART (mainly stavudine, lamivudine, and nevirapine). Households were visited every week by lay providers, and no clinic visits were scheduled after enrolment. We compared rates of death, hospitalisation, and orphanhood during different study periods and calculated the number needed to treat to prevent an outcome.
233 (17%) of 1373 participants with HIV and 40 (1%) of 4601 HIV-uninfected household members died. During the first 16 weeks of ART and co-trimoxazole, mortality in HIV-infected participants was 55% lower than that during co-trimoxazole alone (14 vs 16 deaths per 100 person-years; adjusted hazard ratio 0.45, 95% CI 0.27-0.74, p=0.0018), and after 16 weeks, was reduced by 92% (3 vs 16 deaths per 100 person-years; 0.08, 0.06-0.13, p<0.0001). Compared with no intervention, ART and co-trimoxazole were associated with a 95% reduction in mortality in HIV-infected participants (5 vs 27 deaths per 100 person-years; 0.05, 0.03-0.08, p<0.0001), 81% reduction in mortality in their uninfected children younger than 10 years (0.2 vs 1.2 deaths per 100 person-years; 0.19, 0.06-0.59, p=0.004), and a 93% estimated reduction in orphanhood (0.9 vs 12.8 per 100 person-years of adults treated; 0.07, 0.04-0.13, p<0.0001).
Expansion of access to ART and co-trimoxazole prophylaxis could substantially reduce mortality and orphanhood among adults with HIV and their families living in resource-poor settings.
- SourceAvailable from: Margaret Kyakuwa[Show abstract] [Hide abstract]
ABSTRACT: Margaret Kyakuwa onderzocht de rol van hiv-positieve verpleegsters in twee behandelcentra voor hiv/aids in Uganda. Ze bekeek wat er gebeurt met de identiteit van de verpleegsters wanneer hun persoonlijke leven en sociale omgeving verandert als gevolg van de aidsepidemie en behandeling met antiretrovirale therapie (ART). Ook onderzocht Kyakuwa hoe de ziekte de zorgrelaties van de verpleegsters beïnvloedt. Uit haar onderzoek blijkt dat verpleegsters die werkzaam zijn in de publieke kliniek vaak kiezen voor een leven van geheimzinnigheid en verschuiling. Kyakuwa concludeert daarnaast dat hiv-positieve verpleegsters betere zorgverleners zijn, door de toegevoegde waarde van hun persoonlijke ervaring. Zulke verpleegsters blijken pragmatischer en flexibeler te zijn. In plaats van zich strikt te houden aan medisch-ethische codes van objectiviteit en afstandelijkheid, hechten zij meer waarde aan relaties die gebaseerd zijn op vertrouwen, onderlinge afhankelijkheid, creativiteit en samenwerking. Dit moeten de verpleegsters zien te bereiken binnen beperkte kaders, wat een constante herziening van keuzes vereist.
- [Show abstract] [Hide abstract]
ABSTRACT: We describe older (> 50 years) HIV-infected adults after ART initiation, evaluating immunological recovery by age category, considering individual trajectories based on the pre-treatment CD4. We also describe mortality on ART and its risk factors by age category including the contribution of poor immunological recovery at a large urban clinic in Kampala, Uganda.JAIDS Journal of Acquired Immune Deficiency Syndromes 08/2014; DOI:10.1097/QAI.0000000000000330 · 4.39 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: After more than a decade of establishing and expanding access to highly active antiretroviral therapy (HAART), empirical evidence on its impact on trends of opportunistic infections (OIs) associated with the deadly human immunodeficiency virus (HIV) in resource poor settings is scarce. The primary objective of this study was to assess the effect of HAART coverage on trends of five most common OIs in Uganda. Observational data from January 2002 to December 2013 for 5972 HIV positive individuals attending the AIDS Support Organisation (TASO) HIV/AIDS care programme in Uganda were extracted and analysed. Trends were analysed using autoregressive moving average time series and mixed effects linear regression models adjusting for all available potential confounders. A total of 204,871 monthly medical reports were retrieved and analysed. Majority of the participants were female (73%) with a median age of 32 years (inter-quartile range 26-39). Overall, significant decreasing mean annual prevalence trends were observed for mycobacterium tuberculosis, herpes zoster, genital ulcer and oral candidiasis (p < 0.05, X(2) trend). Non-significant declining mean annual prevalence trend was observed for cryptococcal meningitis (p = 0.181, X(2) trend). The largest impact of HAART was observed in Oral candidiasis and TB whose average annual prevalence reduced by 61% and 43% respectively following the introduction of HAART. Monthly series for TB, Herpes zoster and genital ulcers differed significantly by age and clinic but only genital ulcer series differed significantly by sex (p < 0.05, kruskal wallis). After controlling for the effects of age, sex and clinic (fixed) and monthly clustering (random effect) in a mixed effects linear regression model, all the five OIs showed a significant monthly change in prevalence (p < 0.001). Overall, prevalence of most OIs declined especially after the introduction of HAART. However significant variations exist in the trends of different OIs in different geographical areas in Uganda. It is therefore important that site specific factors are properly identified to enable the development of targeted interventions.BMC Infectious Diseases 04/2015; 15(1):187. DOI:10.1186/s12879-015-0927-7 · 2.56 Impact Factor